title: Sensitivity and specificity of the Streptococcus pneumoniae urinary antigen test for unconcentrated urine from adult patients with pneumonia: a meta-analysis.
abstract: Studies on the sensitivity and specificity of the Binax Now Streptococcus pneumonia urinary antigen test (index test) show considerable variance of results. Those written in English provided sufficient original data to evaluate the sensitivity and specificity of the index test using unconcentrated urine to identify S. pneumoniae infection in adults with pneumonia. Reference tests were conducted with at least one culture and/or smear. We estimated sensitivity and two specificities. One was the specificity evaluated using only patients with pneumonia of identified other aetiologies ('specificity (other)'). The other was the specificity evaluated based on both patients with pneumonia of unknown aetiology and those with pneumonia of other aetiologies ('specificity (unknown and other)') using a fixed model for meta-analysis. We found 10 articles involving 2315 patients. The analysis of 10 studies involving 399 patients yielded a pooled sensitivity of 0.75 (95% confidence interval: 0.71-0.79) without heterogeneity or publication bias. The analysis of six studies involving 258 patients yielded a pooled specificity (other) of 0.95 (95% confidence interval: 0.92-0.98) without no heterogeneity or publication bias. We attempted to conduct a meta-analysis with the 10 studies involving 1916 patients to estimate specificity (unknown and other), but it remained unclear due to moderate heterogeneity and possible publication bias. In our meta-analysis, sensitivity of the index test was moderate and specificity (other) was high; however, the specificity (unknown and other) remained unclear.
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Horita
authors.forename: Naoki
authors.initials: N
authors.lastname: Miyazawa
authors.forename: Ryota
authors.initials: R
authors.lastname: Kojima
authors.forename: Naoko
authors.initials: N
authors.lastname: Kimura
authors.forename: Miyo
authors.initials: M
authors.lastname: Inoue
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kaneko
mesh_terms: D000942:Antigens, Bacterial / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D006801:Humans; D007159:Immunologic Tests / Q000379:methods*; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology* / Q000652:urine; D012680:Sensitivity and Specificity; D013296:Streptococcus pneumoniae / Q000276:immunology*
chemical_list: D000942:Antigens, Bacterial; D015415:Biomarkers
keywords: community acquired pneumonia; diagnostic test; infectious disease; rapid test; systematic review