对患有急性呼吸衰竭的免疫功能低下成人进行 PCR 和 B-D 葡聚糖检测以诊断吉罗韦氏肺囊虫肺炎的结果解读。

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Laure Calvet, Virginie Lemiale, Djamel Mokart, Schellongowski Peter, Pickkers Peter, Alexande Demoule, Sangeeta Mehta, Achille Kouatchet, Jordi Rello, Philippe Bauer, Ignacio Martin-Loeches, Amelie Seguin, Victoria Metaxa, Magali Bisbal, Elie Azoulay, Michael Darmon
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引用次数: 0

摘要

背景:诊断测试的准确性取决于其内在特征和疾病发病率。本研究旨在根据急性呼吸衰竭(ARF)患者的 PCR 和β-D-葡聚糖(BDG)检测结果,描述检测后肺孢子虫肺炎(PJP)的概率:从文献中提取 PCR 和 BDG 的诊断性能。在 2243 名患有 ARF 的非艾滋病毒免疫功能低下患者的数据集中评估了肺孢子虫肺炎的发病率。在 5000 个随机发病样本中,假设肺孢子虫肺炎的发病率为正态分布,对其进行模拟。使用贝叶斯定理评估了检测后的概率:非艾滋病毒 ARF 患者的 PJP 发病率为 4.1%(95%CI 3.3-5)。监督分类确定了 4 个感兴趣的亚组,发病率从 2.0%(无磨玻璃不透明;95%CI 1.4-2.8)到 20.2%(造血细胞移植、磨玻璃不透明和无 PJP 预防措施;95%CI 14.1-27.7)不等。在总体人群中,PCR 和 BDG 检测后的阳性概率分别为 32.9%(95%CI 31.1-34.8)和 22.8%(95%CI 21.5-24.3)。PCR 和 BDG 检测后的阴性感染概率分别为 0.10%(95%CI 0.09-0.11)和 0.23%(95%CI 0.21-0.25)。在高风险亚组中,PCR 和 BDG 的阳性预测值分别为 74.5%(95%CI 72.0-76.7)和 63.8%(95%CI 60.8-65.8):结论:尽管这两种检测方法都具有较高的内在性能,但由于该队列中 PJP 的发病率较低,因此检测后的阳性概率也较低。我们提出了一种说明检测前和检测后概率关系的方法,该方法可提高临床医生在预定义的临床环境中根据疾病发病率对诊断检测性能的认识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Interpretation of results of PCR and B-D-glucan for the diagnosis of Pneumocystis Jirovecii Pneumonia in immunocompromised adults with acute respiratory failure.

Interpretation of results of PCR and B-D-glucan for the diagnosis of Pneumocystis Jirovecii Pneumonia in immunocompromised adults with acute respiratory failure.

Background: The accuracy of a diagnostic test depends on its intrinsic characteristics and the disease incidence. This study aims to depict post-test probability of Pneumocystis pneumonia (PJP), according to results of PCR and Beta-D-Glucan (BDG) tests in patients with acute respiratory failure (ARF).

Materials and methods: Diagnostic performance of PCR and BDG was extracted from literature. Incidence of Pneumocystis pneumonia was assessed in a dataset of 2243 non-HIV immunocompromised patients with ARF. Incidence of Pneumocystis pneumonia was simulated assuming a normal distribution in 5000 random incidence samples. Post-test probability was assessed using Bayes theorem.

Results: Incidence of PJP in non-HIV ARF patients was 4.1% (95%CI 3.3-5). Supervised classification identified 4 subgroups of interest with incidence ranging from 2.0% (No ground glass opacities; 95%CI 1.4-2.8) to 20.2% (hematopoietic cell transplantation, ground glass opacities and no PJP prophylaxis; 95%CI 14.1-27.7). In the overall population, positive post-test probability was 32.9% (95%CI 31.1-34.8) and 22.8% (95%CI 21.5-24.3) for PCR and BDG, respectively. Negative post-test probability of being infected was 0.10% (95%CI 0.09-0.11) and 0.23% (95%CI 0.21-0.25) for PCR and BDG, respectively. In the highest risk subgroup, positive predictive value was 74.5% (95%CI 72.0-76.7) and 63.8% (95%CI 60.8-65.8) for PCR and BDG, respectively.

Conclusion: Although both tests yield a high intrinsic performance, the low incidence of PJP in this cohort resulted in a low positive post-test probability. We propose a method to illustrate pre and post-test probability relationship that may improve clinician perception of diagnostic test performance according to disease incidence in predefined clinical settings.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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