title: NS1-based tests with diagnostic utility for confirming dengue infection: a meta-analysis.
abstract: OBJECTIVE
  Non-structural protein 1 (NS1)-based tests may offer a larger window of opportunity for dengue diagnosis and could constitute a very useful diagnostic tool. The aim of this study was to establish the overall accuracy of NS1-based tests for diagnosing dengue infection.
  
  
  METHODS
  A meta-analysis was conducted including 18 studies published up to October 1, 2012 identified using PubMed, ISI Web of Science, Google Scholar, and the Chinese National Knowledge Infrastructure (CNKI) database.
  
  
  RESULTS
  For the single NS1-based tests - ELISA (Panbio Dengue Early ELISA Kit, Dengue NS1 Ag ELISA Kit, and Platelia Dengue NS1 Ag-ELISA Kit) and immunochromatography (Dengue NS1 Ag STRIP Kit and SD BIOLINE Dengue Duo Strip Kit) - the summarized sensitivities and specificities were 67% (95% confidence interval (CI) 59-74%) and 99% (95% CI 97-99%), and 71% (95% CI 61-79%) and 99% (95% CI 98-100%), respectively. The hierarchical summary receiver operating characteristics (HSROCs) were 0.92 and 0.96, respectively. For NS1 combined with an anti-dengue-specific IgM test, the summarized sensitivity, specificity, and HSROC were 83% (95% CI 68-92%), 86% (95% CI 79-91%), and 0.91 (95% CI 0.89-0.93), respectively. The accuracy for serotypes was 50.0-90.9% for DENV-1, 38.5-85.7% for DENV-2, 46.7-91.3% for DENV-3, and 21.7-87.0% for DENV-4.
  
  
  CONCLUSIONS
  These results support the use of single NS1-based tests; they have good diagnostic utility for confirming dengue and for distinguishing serotypes DENV-1 and 3 from DENV-2 and 4, while they can be used as a screening tool when combined with an IgM test. Moreover, the Dengue NS1 Ag STRIP Kit appears to be the best for confirming and serotyping dengue infection.
authors.affiliation: Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China; Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Province, School of Public Health and Tropical Medicine, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China.
authors.forename: Junjie
authors.initials: J
authors.lastname: Wang
authors.affiliation: Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Province, School of Public Health and Tropical Medicine, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China.
authors.forename: Hongjuan
authors.initials: H
authors.lastname: Peng
authors.affiliation: Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Che
authors.affiliation: Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Province, School of Public Health and Tropical Medicine, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China. Electronic address: xgchen2001@hotmail.com.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China. Electronic address: yuanpingzhou@163.com.
authors.forename: Yuanping
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D003715:Dengue / Q000175:diagnosis*; D003716:Dengue Virus / Q000145:classification / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007075:Immunoglobulin M; D012372:ROC Curve; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D012703:Serotyping; D017361:Viral Nonstructural Proteins / Q000276:immunology*
chemical_list: D007075:Immunoglobulin M; D011933:Reagent Kits, Diagnostic; D017361:Viral Nonstructural Proteins
keywords: Dengue; Diagnostic accuracy; NS1; Sensitivity; Specificity