Abstract：
BACKGROUND: Cerebrospinal fluid (CSF) galactomannan is an adjunctive test for central nervous system (CNS) aspergillosis diagnosis with unclear diagnostic test characteristics.
OBJECTIVE: To evaluate the diagnostic test characteristics of CSF galactomannan in CNS aspergillosis.
METHODS: Systematic review and meta-analysis.
METHODS: MEDLINE, Embase, Web of Science, and Scopus, from inception to 24 February 2023.
METHODS: Prospective and retrospective studies with 1-group and 2-group designs using any galactomannan assay on CSF to diagnose CNS aspergillosis.
METHODS: Adult and/or paediatric patients with CNS aspergillosis.
UNASSIGNED: Galactomannan testing on CSF specimens.
UNASSIGNED: European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) diagnostic criteria, or equivalent.
UNASSIGNED: QUADAS-2 assessment in duplicate.
UNASSIGNED: Bivariate restricted maximum likelihood estimation random-effects meta-analysis, summarized using forest and summary receiver operating characteristic plots; bivariate meta-regression models to investigate heterogeneity; and subgroup and sensitivity analyses to explore subgroup effects and methodologic choices (PROSPERO registration: CRD42022296331; funding: none).
RESULTS: We included eight studies (n = 342 participants). The summary estimates of CSF galactomannan sensitivity and specificity were 69.0% (95% CI, 57.2-78.7%) and 94.4% (95% CI, 82.8-98.3%), respectively. Using meta-regression, galactomannan cut-off (p = 0.38), EORTC/MSGERC criteria version (p = 0.48), or whether the reference standard was defined as both proven and probable or only proven aspergillosis (p = 0.48) did not explain observed heterogeneity. No subgroup effects were demonstrated by analysing the EORTC/MSGERC criteria reference standard used (e.g. 2002 vs. 2008 definitions) or whether paediatric patients were included. Diagnostic sensitivity was improved using a galactomannan cut-off of 1.0, and by excluding high risk of bias and 1-group design studies.
CONCLUSIONS: CSF galactomannan is a highly specific but insensitive test for use as a component of CNS aspergillosis diagnosis. Few included studies, no prospective studies, and a high risk of bias are study limitations.
OBJECTIVE: To evaluate the diagnostic test characteristics of CSF galactomannan in CNS aspergillosis.
METHODS: Systematic review and meta-analysis.
METHODS: MEDLINE, Embase, Web of Science, and Scopus, from inception to 24 February 2023.
METHODS: Prospective and retrospective studies with 1-group and 2-group designs using any galactomannan assay on CSF to diagnose CNS aspergillosis.
METHODS: Adult and/or paediatric patients with CNS aspergillosis.
UNASSIGNED: Galactomannan testing on CSF specimens.
UNASSIGNED: European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) diagnostic criteria, or equivalent.
UNASSIGNED: QUADAS-2 assessment in duplicate.
UNASSIGNED: Bivariate restricted maximum likelihood estimation random-effects meta-analysis, summarized using forest and summary receiver operating characteristic plots; bivariate meta-regression models to investigate heterogeneity; and subgroup and sensitivity analyses to explore subgroup effects and methodologic choices (PROSPERO registration: CRD42022296331; funding: none).
RESULTS: We included eight studies (n = 342 participants). The summary estimates of CSF galactomannan sensitivity and specificity were 69.0% (95% CI, 57.2-78.7%) and 94.4% (95% CI, 82.8-98.3%), respectively. Using meta-regression, galactomannan cut-off (p = 0.38), EORTC/MSGERC criteria version (p = 0.48), or whether the reference standard was defined as both proven and probable or only proven aspergillosis (p = 0.48) did not explain observed heterogeneity. No subgroup effects were demonstrated by analysing the EORTC/MSGERC criteria reference standard used (e.g. 2002 vs. 2008 definitions) or whether paediatric patients were included. Diagnostic sensitivity was improved using a galactomannan cut-off of 1.0, and by excluding high risk of bias and 1-group design studies.
CONCLUSIONS: CSF galactomannan is a highly specific but insensitive test for use as a component of CNS aspergillosis diagnosis. Few included studies, no prospective studies, and a high risk of bias are study limitations.
摘要：
背景：脑脊液（CSF）半乳甘露聚糖是中枢神经系统（CNS）曲霉病诊断的辅助测试，诊断测试特征不明确。
目的：评价脑脊液半乳甘露聚糖在中枢神经系统曲霉病诊断中的检测特点。
方法：系统评价和荟萃分析。
方法：MEDLINE，Embase,WebofScience,还有Scopus,从成立到2023年2月24日。
方法：前瞻性和回顾性研究，采用一组和两组设计，使用任何半乳甘露聚糖对CSF进行检测来诊断中枢神经系统曲霉病。
方法：成人和/或儿童中枢神经系统曲霉病患者。
■对CSF样本的半乳甘露聚糖测试。
■欧洲癌症研究和治疗组织和真菌病研究小组教育和研究联盟（EORTC/MSGERC）诊断标准，或等效。
■QUADAS-2评估一式两份。
■双变量限制最大似然估计随机效应荟萃分析，使用森林和汇总接受者-操作者特征图进行汇总;双变量元回归模型以调查异质性;亚组和敏感性分析以探索亚组效应和方法学选择(PROSPERO注册:CRD42022296331;资助:无).
结果：我们纳入了8项研究（n=342名参与者）。CSF半乳甘露聚糖敏感性和特异性的汇总估计为69.0％（95％CI：57.2-78.7％）和94.4％（95％CI：82.8-98.3％），分别。使用元回归，半乳甘露聚糖截止值（p=0.38），EORTC/MSGERC标准版本(p=0.48)，或者参考标准是否被定义为已证实和可能或仅被证实的曲霉病(p=0.48)并不能解释观察到的异质性.通过分析使用的EORTC/MSGERC标准参考标准（例如，2002年与2008年的定义）或是否包括儿科患者。使用1.0的半乳甘露聚糖截止值，并通过排除高偏倚风险和一组设计研究来提高诊断灵敏度。
结论：CSF半乳甘露聚糖是一种高度特异性但不敏感的测试，可用作中枢神经系统曲霉病诊断的组成部分。很少包括研究，没有前瞻性研究,和高偏倚风险是研究的局限性。
目的：评价脑脊液半乳甘露聚糖在中枢神经系统曲霉病诊断中的检测特点。
方法：系统评价和荟萃分析。
方法：MEDLINE，Embase,WebofScience,还有Scopus,从成立到2023年2月24日。
方法：前瞻性和回顾性研究，采用一组和两组设计，使用任何半乳甘露聚糖对CSF进行检测来诊断中枢神经系统曲霉病。
方法：成人和/或儿童中枢神经系统曲霉病患者。
■对CSF样本的半乳甘露聚糖测试。
■欧洲癌症研究和治疗组织和真菌病研究小组教育和研究联盟（EORTC/MSGERC）诊断标准，或等效。
■QUADAS-2评估一式两份。
■双变量限制最大似然估计随机效应荟萃分析，使用森林和汇总接受者-操作者特征图进行汇总;双变量元回归模型以调查异质性;亚组和敏感性分析以探索亚组效应和方法学选择(PROSPERO注册:CRD42022296331;资助:无).
结果：我们纳入了8项研究（n=342名参与者）。CSF半乳甘露聚糖敏感性和特异性的汇总估计为69.0％（95％CI：57.2-78.7％）和94.4％（95％CI：82.8-98.3％），分别。使用元回归，半乳甘露聚糖截止值（p=0.38），EORTC/MSGERC标准版本(p=0.48)，或者参考标准是否被定义为已证实和可能或仅被证实的曲霉病(p=0.48)并不能解释观察到的异质性.通过分析使用的EORTC/MSGERC标准参考标准（例如，2002年与2008年的定义）或是否包括儿科患者。使用1.0的半乳甘露聚糖截止值，并通过排除高偏倚风险和一组设计研究来提高诊断灵敏度。
结论：CSF半乳甘露聚糖是一种高度特异性但不敏感的测试，可用作中枢神经系统曲霉病诊断的组成部分。很少包括研究，没有前瞻性研究,和高偏倚风险是研究的局限性。
