title: A systematic review and meta-analysis of the diagnostic accuracy of anti-heat shock protein 70 antibodies for the detection of autoimmune hearing loss.
abstract: OBJECTIVE
  We reviewed case-control studies concerning the diagnostic accuracy of Heat Shock Protein 70 (Hsp-70) auto antibodies in the detection of immunomediated inner ear disease.
  
  
  METHODS
  We searched for relevant articles published in English language on PubMed and Scopus up to December 2011. A quality assessment of the retrieved articles was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Pooled data on the accuracy of the test were calculated, where possible.
  
  
  RESULTS
  Three articles were deemed eligible. Among them, 2 evaluated the relationship between Hsp-70 and immunomediated inner ear disease by using the Western blot, whereas one report used the enzyme-linked immunosorbent assay method. Pooled sensitivity of Western blot test for Hsp-70 was 0.70 (95% confidence interval [CI], 0.59-0.80), with a large heterogeneity (I = 72.7%), and pooled specificity was 0.98 (95% CI, 0.87-1.00), with an I of 61.0%. Pooled positive likelihood ratios (LR) was 14.7 (95% CI, 2.1-104.1; I = 31.4%), and pooled negative LR was 0.32 (95% CI, 0.10-0.70; I = 78.8%). Sensitivity and specificity of enzyme-linked immunosorbent assay test for Hsp-70 auto antibodies was 0.85 (95% CI, 0.55-0.98) and 0.98 (95% CI, 0.86-1.00). Risk of bias was performed by using QUADAS 2 tool, with high scores obtained for patient selection and index test domains and low for the applicability criterion.
  
  
  CONCLUSIONS
  This review shows that studies on autoimmune hearing loss diagnosis based on the detection of Hsp-70 autoantibodies used different inclusion and methodologic criteria and are affected from potential bias. Additional studies are actually required to identify an accurate laboratory diagnostic method for the autoimmune hearing loss.
authors.affiliation: Institute of Hygiene, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Ianuale
authors.forename: Gabriella
authors.initials: G
authors.lastname: Cadoni
authors.forename: Emma
authors.initials: E
authors.lastname: De Feo
authors.forename: Luca
authors.initials: L
authors.lastname: Liberati
authors.forename: Rachel Kamgaing
authors.initials: RK
authors.lastname: Simo
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paludetti
authors.forename: Walter
authors.initials: W
authors.lastname: Ricciardi
authors.forename: Stefania
authors.initials: S
authors.lastname: Boccia
mesh_terms: D000906:Antibodies; D001327:Autoimmune Diseases / Q000175:diagnosis*; D015153:Blotting, Western; D003627:Data Interpretation, Statistical; D004797:Enzyme-Linked Immunosorbent Assay; D018840:HSP70 Heat-Shock Proteins / Q000276:immunology*; D034381:Hearing Loss / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D016013:Likelihood Functions; D017594:Publication Bias; D012107:Research Design; D012680:Sensitivity and Specificity
chemical_list: D000906:Antibodies; D018840:HSP70 Heat-Shock Proteins