Diagnostic Performance Of Serum Galactomance And β-D-glucan For Invasive Aspergillosis:a Meta-analysis

Background:Serum galactomannan(GM)and 1,3–b–D-glucan(BG)are known markers of invasive aspergillosis(IA).The aim of this meta-analysis was to evaluate the efficiency of GM and BG for IA diagnosis and compare the performance of the combined tests with either test individually.Methods:A literature search was carried out using PubMed,Web of Science,EMBASE databases and Cochran library to include relevant studies published in English as of May 2019.The quality assessment was performed in Review Manager 5.3 software.A bivariate model was applied to pool diagnostic parameters through Stata 12.0 software.We used Q test and I~2 index to assess heterogeneity and identify the potential source of heterogeneity by meta-regression.The publication bias was evaluated through Deeks’funnel plot.The paired t test was used to compare the value of GM and BG for IA diagnosis when used in combination or alone.Results:Fourteen studies were eligible for inclusion within the meta-analysis.For proven or probable IA,serum GM and BG yielded a pooled sensitivity of 0.50(95%CI 0.40–0.61)vs.0.74(95%CI0.62–0.83),a pooled specificity of 0.95(95%CI 0.91–0.97)vs.0.80(95%CI 0.70–0.88).The area under the curve(AUC)was 0.83(95%CI0.79–0.86)vs.0.84(95%CI 0.80–0.87)for all studies.The pooled sensitivity and specificity for IA diagnosis by combined GM and BG assays(GM/BG)were 0.78(95%CI 0.66,0.86)and 0.86(95%CI0.61,0.96),respectively.The AUC of the combined GM/BG test to diagnose IA was 0.84(95%CI 0.80–0.87).Conclusion:Serum GM and BG tests had a relatively high accuracy for IA diagnosis in suspected patients.The diagnostic accuracy of both assays is comparable,and the combined detection of the two methods can further improve the diagnostic sensitivity.