title: Evaluation of PCR in bronchoalveolar lavage fluid for diagnosis of Pneumocystis jirovecii pneumonia: a bivariate meta-analysis and systematic review.
abstract: BACKGROUND
  As a promising tool, PCR in bronchoalveolar lavage fluid (BALF) has not been accepted as a diagnostic criterion for PJP.
  
  
  OBJECTIVE
  We undertook a systematic review of published studies to evaluate the diagnostic accuracy of PCR assays in BALF for PJP.
  
  
  METHODS
  Eligible studies from PubMed, Embase and Web of Science reporting PCR assays in BALF for diagnosing PJP were identified. A bivariate meta-analysis of the method's sensitivity, specificity, and positive and negative likelihood ratios with a 95% confidence interval (CI) were analyzed. The post-test probability was performed to evaluate clinical usefulness. A summary receiver operating characteristics (SROC) curve was used to evaluate overall performance. Subgroup analyses were carried out to analysis the potential heterogeneity.
  
  
  RESULTS
  Sixteen studies published between 1994 and 2012 were included. The summary sensitivity and specificity values (95% CI) of PCR in BALF for diagnosis of PJP were 98.3% (91.3%-99.7%) and 91.0% (82.7%-95.5%), respectively. The positive and negative likelihood ratios were 10.894 (5.569-21.309) and 0.018 (0.003-0.099), respectively. In a setting of 20% prevalence of PJP, the probability of PJP would be over 3-fold if the BALF-PCR test was positive, and the probability of PJP would be less than 0.5% if it was negative. The area under the SROC curve was 0.98 (0.97-0.99).
  
  
  CONCLUSIONS
  The method of PCR in BALF shows high sensitivity and good specificity for the diagnosis of PJP. However, clinical practice for the diagnosis of PJP should consider the consistent respiratory symptoms, radiographic changes and laboratory findings of the suspected patients.
authors.affiliation: Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Li-Chao
authors.initials: LC
authors.lastname: Fan
authors.forename: Hai-Wen
authors.initials: HW
authors.lastname: Lu
authors.forename: Ke-Bin
authors.initials: KB
authors.lastname: Cheng
authors.forename: Hui-Ping
authors.initials: HP
authors.lastname: Li
authors.forename: Jin-Fu
authors.initials: JF
authors.lastname: Xu
mesh_terms: D000704:Analysis of Variance; D001992:Bronchoalveolar Lavage Fluid; D002986:Clinical Trials as Topic; D006801:Humans; D045363:Pneumocystis carinii / Q000502:physiology*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis*; D016133:Polymerase Chain Reaction / Q000379:methods*
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