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Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients.
Eur Respir J. 2002 Oct; 20(4):982-9.ER

Abstract

Sputum induction is a simple and noninvasive procedure for Pneumocystis carinii pneumonia (PCP) diagnosis in human immunodeficiency virus-1-positive patients, although less sensitive than bronchoalveolar lavage (BAL). In order to obtain an overview of the diagnostic accuracy of sputum induction, a systematic review and meta-analysis of studies reporting the comparative sensitivity and specificity of BAL (the "gold standard") and sputum induction was performed. The odds ratio and related 95% confidence interval were calculated using summary receiving operating characteristic curves as well as fixed-effect and random-effect models. Based on pooled data, the negative and positive predictive values were calculated for a range of PCP prevalence using a Bayesian approach. Seven prospective studies assessed the comparative accuracy of BAL and sputum induction. On the whole, sputum induction demonstrated 55.5% sensitivity and 98.6% specificity. The sensitivity of sputum induction was significantly higher with immunofluorescence than with cytochemical staining (67.1 versus 43.1%). In settings of 25-60% prevalence of PCP, the positive and negative predictive values ranged 86-96.7 and 66.2-89.8, respectively, with immunofluorescence, and 79-94.4 and 53-83.5% with cytochemical staining. In conclusion, in a setting of low prevalence of Pneumocystis carinii pneumonia, sputum induction, particularly with immunostaining, appears to be adequate for clinical decision-making.

Authors+Show Affiliations

Cruciani M
Center of Preventive Medicine HIV Outpatient Clinic, Verona, Italy. crucianimario@virgilio.it
Marcati P
No affiliation info available
Malena M
No affiliation info available
Bosco O
No affiliation info available
Serpelloni G
No affiliation info available
Mengoli C
No affiliation info available

MeSH

AIDS-Related Opportunistic InfectionsAdolescentAdultBronchoalveolar Lavage FluidConfidence IntervalsFemaleHumansMaleMiddle AgedOdds RatioPneumonia, PneumocystisROC CurveSensitivity and SpecificitySputum

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

12412693

Citation

Cruciani, M, et al. "Meta-analysis of Diagnostic Procedures for Pneumocystis Carinii Pneumonia in HIV-1-infected Patients." The European Respiratory Journal, vol. 20, no. 4, 2002, pp. 982-9.
Cruciani M, Marcati P, Malena M, et al. Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients. Eur Respir J. 2002;20(4):982-9.
Cruciani, M., Marcati, P., Malena, M., Bosco, O., Serpelloni, G., & Mengoli, C. (2002). Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients. The European Respiratory Journal, 20(4), 982-9.
Cruciani M, et al. Meta-analysis of Diagnostic Procedures for Pneumocystis Carinii Pneumonia in HIV-1-infected Patients. Eur Respir J. 2002;20(4):982-9. PubMed PMID: 12412693.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients. AU - Cruciani,M, AU - Marcati,P, AU - Malena,M, AU - Bosco,O, AU - Serpelloni,G, AU - Mengoli,C, PY - 2002/11/5/pubmed PY - 2003/2/22/medline PY - 2002/11/5/entrez SP - 982 EP - 9 JF - The European respiratory journal JO - Eur Respir J VL - 20 IS - 4 N2 - Sputum induction is a simple and noninvasive procedure for Pneumocystis carinii pneumonia (PCP) diagnosis in human immunodeficiency virus-1-positive patients, although less sensitive than bronchoalveolar lavage (BAL). In order to obtain an overview of the diagnostic accuracy of sputum induction, a systematic review and meta-analysis of studies reporting the comparative sensitivity and specificity of BAL (the "gold standard") and sputum induction was performed. The odds ratio and related 95% confidence interval were calculated using summary receiving operating characteristic curves as well as fixed-effect and random-effect models. Based on pooled data, the negative and positive predictive values were calculated for a range of PCP prevalence using a Bayesian approach. Seven prospective studies assessed the comparative accuracy of BAL and sputum induction. On the whole, sputum induction demonstrated 55.5% sensitivity and 98.6% specificity. The sensitivity of sputum induction was significantly higher with immunofluorescence than with cytochemical staining (67.1 versus 43.1%). In settings of 25-60% prevalence of PCP, the positive and negative predictive values ranged 86-96.7 and 66.2-89.8, respectively, with immunofluorescence, and 79-94.4 and 53-83.5% with cytochemical staining. In conclusion, in a setting of low prevalence of Pneumocystis carinii pneumonia, sputum induction, particularly with immunostaining, appears to be adequate for clinical decision-making. SN - 0903-1936 UR - https://www.unboundmedicine.com/medline/citation/12412693/Meta_analysis_of_diagnostic_procedures_for_Pneumocystis_carinii_pneumonia_in_HIV_1_infected_patients_ DB - PRIME DP - Unbound Medicine ER -