Please use this identifier to cite or link to this item: http://hdl.handle.net/11054/29
Title: Does gram-negative bacteraemia occur without endotoxaemia? A meta-analysis using hierarchical summary ROC curves.
Authors: Hurley, James C.
Issue Date: 2010
Publisher: Springer
Place of publication: Berlin
Publication Title: European Journal of Clinical Microbiology & Infectious Diseases
Volume: 29
Issue: 2
Start Page: 207
End Page: 215
Abstract: The limulus assay for endotoxin has been studied as a method for the rapid identification of gram-negative (GN) bacteraemia. The chromogenic (C-limulus) version is 100-fold more sensitive to an internal endotoxin standard than the earlier gelation version (G-limulus). The objective of this analysis is to compare the concordance between GN bacteraemia and endotoxaemia as determined in clinical studies using either version of the limulus assay. The summary results for the diagnostic odds ratio (DOR), sensitivity and specificity were derived using a hierarchical summary receiver operating characteristic (HSROC) method of meta-analysis. Fifty-eight studies (25 G-limulus and 33 C-limulus) were included. Surprisingly, the mean DOR (4.9; 3-7.9 versus 10.7; 5.2-21.8) was inferior for studies using the C-limulus versus the original G-limulus version of the assay. Moreover, among studies limited to sepsis syndrome patients, the mean DOR remains poor at 4.2 (1.8-9.5). The proportion of GN bacteraemic patients for whom endotoxaemia is not detectable with either version of the limulus assay is >20% among the 58 studies overall, but >30% after the exclusion of studies with <25 patients and >20% among studies of patients with sepsis syndrome. These findings help to reconcile seemingly disparate study results.
URI: http://hdl.handle.net/11054/29
ISSN: 0934-9723
Internal ID Number: 00016
Health Subject: META ANALYSIS
ENDOTOXEMIA - DIAGNOSIS
HUMANS
LIMULUS TEST
STATISTICS AS TOPIC
GRAM NEGATIVE BACTERIAL INFECTIONS - DIAGNOSIS
GRAM NEGATIVE BACTERIAL INFECTIONS - COMPLICATIONS
Type: Journal Article
Article
Appears in Collections:Research Output

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