Diagnosing tuberculosis with urine lipoarabinomannan: systematic review and meta-analysis

Diagnosing tuberculosis with urine lipoarabinomannan:
systematic review and meta-analysis

Eur Respir J. 2011; 38(6):1398-405 (ISSN: 1399-3003)

Minion J ; Leung E ; Talbot E ; Dheda K ; Pai M ; Menzies D

Dept of Epidemiology, Biostatistics and Occupational Health, McGill University,
Montreal, QC, Canada.

Lipoarabinomannan (LAM) is a potential marker of active
tuberculosis (TB). We performed a systematic review and meta-analysis regarding
use of urinary LAM assays for diagnosing active TB. We systematically searched
for published and unpublished studies that evaluated urinary LAM for active TB
diagnosis. Extracted data were pooled using bivariate random effects models and
hierarchical summary receiver operating characteristic curves. Heterogeneity
was explored through subgroup analysis and meta-regression. Quality was
assessed according to standardised QUADAS (Quality Assessment of Diagnostic
Accuracy Studies) criteria. In seven studies that assessed test accuracy in
microbiologically confirmed cases only, estimates of sensitivity ranged from
13% to 93%, while specificity ranged from 87% to 99%. In five studies that
assessed accuracy in clinical and confirmed TB cases, sensitivity ranged
from 8% to 80%, while specificity ranged from 88% to 99%. In five studies
with results stratified by HIV status, sensitivity was 3-53% higher in
HIV-positive than HIV-negative subgroups; sensitivity was highest with
advanced immunosuppression. The LAM urinary assay has several
characteristics that make it attractive for diagnosing active TB, but has
suboptimal sensitivity for routine clinical use. Further studies are needed to
evaluate the potential value of the LAM assay in individuals with advanced HIV
or for diagnosis of paediatric TB.