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Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients Cruciani M; Marcati P; Malena M; Bosco O; Serpelloni G; Mengoli CEur Respir J 2002[Oct]; 20 (4): 982-9Sputum 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.|AIDS-Related Opportunistic Infections/*diagnosis/epidemiology[MESH]|Adolescent[MESH]|Adult[MESH]|Bronchoalveolar Lavage Fluid/*microbiology[MESH]|Confidence Intervals[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Odds Ratio[MESH]|Pneumonia, Pneumocystis/*diagnosis/epidemiology[MESH]|ROC Curve[MESH]|Sensitivity and Specificity[MESH]|Sputum/*microbiology[MESH] |
