The diagnosis accuracy of PLA2R-AB in the diagnosis of idiopathic membranous nephropathy: a meta-analysis

Abstract

Background: The presence of antibodies against the M-type phospholipase A2 receptor (PLA2R-AB) is considered to be a promising serological diagnostic biomarker of idiopathic membranous nephropathy (iMN). However, controversy remains about the diagnostic accuracy of serum PLA2R-AB testing. Here, we performed a comprehensive meta-analysis to assess the overall diagnostic value of serum PLA2R-AB testing in iMN detection.

Methods: PubMed, Embase, and CNKI (Chinese National Knowledge Infrastructure) were searched for relevant original articles through January 31, 2014. The summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (DOR) were estimated using the bivariate model. The heterogeneity among studies was explored by subgroup and meta-regression analysis.

Results: 9 articles, including 15 studies, were eventually identified with a total of 2212 patients. The summary sensitivity of all studies is 78% (95% CI: 66% to 87%) and the specificity is 99% (95% CI: 96% to 100%). The summary positive and negative likelihood ratios are 96.1 (95% CI, 19.5 to 472.1) and 0.22 (95% CI: 0.14 to 0.35), respectively. The DOR is 437 (95%CI, 74 to 2592). The subgroup analysis and meta-regression suggest the test interval is the main source of heterogeneity.

Conclusions: Serum PLA2R-AB testing is a useful tool to detect iMN. In addition, considering the high heterogeneity and potential publication bias, further high quality studies are needed in the future.

Figure 1. Flowchart for identification of studies.

Figure 2. Proportion of all 14 quality assessment of diagnostic accuracy studies tool criteria that were fulfilled for the studies included in the meta-analysis.

Figure 3. Forrest plots of the sensitivity and specificity of each individual study, summary sensitivity and specificity and I² statistic for heterogeneity.

Figure 4. Summary receiver operating characteristic (SROC) graph with 95% confidence region and 95% prediction region for the diagnosis value of iMN by PLA2R-AB.

Black square represents the summary estimate of sensitivity and specificity with the 95% confidence ellipse from the bivariate model. Numbers represent the reference numbers.