Fungal Genomics & Biology
Open Access

Abstract

A Systematic Review and Meta-Analysis of Diagnostic Accuracy of Serum (1-3)-Beta-D-glucan for Pneumocystis jirovecii Pneumonia Using the Fungitell Assay: Focus on Cutoff Levels

W. Long, K. Xiao and Y. Yuan*

Purpose: We conducted a meta-analysis to evaluate the diagnostic performance of various levels of serum (1-3)-Beta- D-glucan (BDG) for Pneumocystis jirovecii (PJ) infection using Fungitell assay.

Methods: EMBASE, MEDLINE, and the reference lists of relevant studies were identified up to March 12, 2021, with no language restrictions. Meta-analysis was performed using random-effects models for bivariate analysis. Subgroup analyses were implemented in HIV-positive Pneumocystis jirovecii pneumonia (PJP), HIV-negative PJP, and PJP versus colonized patients.

Results: Nineteen individual studies that included a total of 2,310 participants met our inclusion criteria. The overall sensitivity, specificity, positive likelihood ratio(LR+) and negative likelihood ratio (LR-),and 95% confidence interval CI of serum-BDG were 0.94(95% CI: 0.89-0.96),0.76 (95% CI: 0.65-0.85), 3.99 (95% CI: 2.59-6.13),0.08 (95% CI: 0.05-0.15), respectively. Further stratified analysis of diagnostic values showed that various levels of serum BDG differed in sensitivity, specificity, LR+ and LR- in the diagnosis of PJP. Subgroup analyses also indicated that the cutoff value of 200 pg/mL had sufficient diagnostic accuracy in HIV-positive PJP patients versus controls. Moreover, the 80 pg/mL cutoff value had satisfactory diagnostic accuracy in PJP versus colonized patients, an overall sensitivity of 0.86 (95% CI, 0.73-0.93), an overall specificity of 0.82(95% CI, 0.73-0.88), an overall LR+ 4.70(95% CI: 3.11-7.08) and an overall LR- 0.17(95% CI: 0.09-0.34), individually.

Conclusion: This meta-analysis suggests that the optimal positive threshold for serum BDG, tested by the Fungitell assay, requires better definition and clinical validation rather than the recommended cutoff of 80 pg/mL by the manufacturer in the diagnosis of PJP. These cutoff values could be further refined in additional studies that focus on populations that are as homogeneous as possible.

Published Date: 2022-07-05; Received Date: 2022-06-01