Accuracy of β -D-glucan for the diagnosis of Pneumocystis jirovecii pneumonia: a meta-analysis

Abstract

Pneumocystis jirovecii pneumonia (PCP) can affect various types of immunocompromised patients. We sought to evaluate the diagnostic accuracy of (1→3)-β-D-glucan (BDG) for the diagnosis of PCP. We carried out a meta-analysis of relevant studies, identified through PubMed and Scopus. Eligible studies were those that reported BDG diagnostic data in cases with documented PCP and controls with other conditions. Cases of invasive fungal infections and healthy controls were excluded. We performed a bivariate meta-analysis of sensitivity and specificity and constructed a hierarchical summary receiver operating characteristics (HSROC) curve. Fourteen studies were included in the meta-analysis. BDG data were analysed for 357 PCP cases and 1723 controls. The average (95% confidence interval) sensitivity and specificity of BDG were 94.8% (90.8-97.1%) and 86.3% (81.7-89.9%), respectively. The positive and negative likelihood ratios were 6.9 (5.1-9.3) and 0.06 (0.03-0.11), respectively. The area under the HSROC curve was 0.965 (0.945-0.978). Serum BDG shows excellent sensitivity and very good specificity in the diagnosis of PCP. Still, in clinical practice the test results should be interpreted in the context of the underlying clinical characteristics of the individual patient.

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with <b><i>Pneumocystis jirovecii</i></b> Pneumonia

“…A highly sensitive diagnostic method is the serum (1,3)-β-D-glucan assay characterized by its high negative predictive value that makes a PCP infection unlikely in patients with a negative test result [47]. However, it should not be used as a single diagnostic test for PCP, and positive results should trigger a bronchoscopy with BAL [48, 49].…”

Molecular and Nonmolecular Diagnostic Methods for Invasive Fungal Infections

“…A newer serologic method that was not involved in the previous analysis and that deserves to be mentioned is the ␤-glucan assay (88). A recent meta-analysis indicated that ␤-glucan assay performed on serum has a sensitivity and specificity of 94.8% and 86.3%, respectively, for the diagnosis of Pneumocystis pneumonia (89), while a large retrospective cohort showed that a positive ␤-glucan test correlates well with BAL fluid fungal loads (90). Therefore, ␤-glucan assay can be an excellent screening tool to rule out the disease in at-risk populations (88), while additional confirmatory tests are necessary because of the high rate of false-positive results (90).…”

Point-Counterpoint: β- d -Glucan Testing Is Important for Diagnosis of Invasive Fungal Infections

“…As with other fungal pathogens, BDG is a major component of the P. jirovecii surface structure and has been considered a potential marker for PCP. Recently, a meta-analysis evaluating 11 retrospective studies of patients with laboratory-confirmed PCP and at-risk patient controls found a pooled sensitivity and specificity of 94.8% and 86.3%, respectively, for detection of BDG in cases of proven PCP (19). Additionally, this group reported a diagnostic odds ratio of 113.7 for the presence of PCP in the setting of a positive BDG result.…”