title: Diagnosis of pneumocystis pneumonia using serum (1-3)-β-D-Glucan: a bivariate meta-analysis and systematic review.
abstract: BACKGROUND
  The (1-3)-β-D-Glucan (BG) assay has been approved for making a diagnosis of invasive fungal disease. However, the role of serum-BG assay for the diagnosis of pneumocystis pneumonia (PCP) is controversial, especially between patients with human immunodeficiency virus (HIV) and non-HIV. We conducted a meta-analysis to determine the difference of the overall accuracy of serum-BG assay for the diagnosis of PCP in immunocompromised patients with and without HIV.
  
  
  METHODS
  After a systematic review of English-language studies and manual researching, sensitivity (Se), specificity (Sp), and other measures of accuracy of serum-BG for the diagnosis of PCP were pooled using random-effects models for bivariate meta-analysis. Summary receiver operating characteristic (SROC) curve was used to summarize overall test performance. Subgroup analyses were performed to explore the heterogeneity in Se and Sp.
  
  
  RESULTS
  Thirteen studies met our inclusion criteria. The summary estimates for serum-BG assay for definite PCP were as follows: Se, 0.91 [95% confidence interval (CI), 0.88-0.93]; Sp, 0.75 (95% CI, 0.68-0.81). As for the patients with and without HIV, the Se and Sp were 0.92 and 0.78, 0.85 and 0.73, respectively. Significant heterogeneity between Se was presented (P=0.04).
  
  
  CONCLUSIONS
  Contrary to the results of the previous meta-analysis, a negative result of serum-BG determination is sufficient for ruling out PCP only in HIV cases. For non-HIV patients, the results should be interpreted in parallel with clinical and radiological findings. Besides, further prospective studies with larger sample size are needed to confirm the diagnosis strategy of BG detection.
authors.affiliation: 1 Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China ; 2 Affiliated Nursing School, Guangxi Medical University, Nanning 530021, China ; 3 Department of Respiratory Disease, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
authors.forename: Wei-Jie
authors.initials: WJ
authors.lastname: Li
authors.affiliation: 1 Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China ; 2 Affiliated Nursing School, Guangxi Medical University, Nanning 530021, China ; 3 Department of Respiratory Disease, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Guo
authors.affiliation: 1 Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China ; 2 Affiliated Nursing School, Guangxi Medical University, Nanning 530021, China ; 3 Department of Respiratory Disease, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
authors.forename: Tang-Juan
authors.initials: TJ
authors.lastname: Liu
authors.affiliation: 1 Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China ; 2 Affiliated Nursing School, Guangxi Medical University, Nanning 530021, China ; 3 Department of Respiratory Disease, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Wang
authors.affiliation: 1 Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China ; 2 Affiliated Nursing School, Guangxi Medical University, Nanning 530021, China ; 3 Department of Respiratory Disease, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
authors.forename: Jin-Liang
authors.initials: JL
authors.lastname: Kong
keywords: Beta-D-Glucan; human immunodeficiency virus (HIV); meta-analysis; pneumocystis pneumonia (PCP); sensitivity and specificity (Se and Sp)