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. 2016 Sep 16:6:32924.
doi: 10.1038/srep32924.

The diagnostic accuracy of pericardial and urinary lipoarabinomannan (LAM) assays in patients with suspected tuberculous pericarditis

Shaheen Pandie  1 , Jonathan G Peter  2   3   4 , Zita S Kerbelker  1 , Richard Meldau  3   4 , Grant Theron  3   4 , Ureshnie Govender  3   4 , Mpiko Ntsekhe  1 , Keertan Dheda  3   4   5 , Bongani M Mayosi  1   5
Affiliations

The diagnostic accuracy of pericardial and urinary lipoarabinomannan (LAM) assays in patients with suspected tuberculous pericarditis

Shaheen Pandie et al. Sci Rep. .

Abstract

We evaluated the diagnostic accuracy of urinary and pericardial fluid (PF) lipoarabinomannan (LAM) assays in tuberculous pericarditis (TBP). From October 2009 through September 2012, 151 patients with TBP were enrolled. Mycobacterium tuberculosis culture and/or pericardial histology were the reference standard for definite TBP. 49% (74/151), 33.1% (50/151) and 17.9% (27/151) of patients had definite-, probable-, and non-TB respectively; 69.5% (105/151) were HIV positive. LAM ELISA had the following sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive values (95% confidence interval): urinary - 17.4% (9.1-30.7), 93.8% (71.7-98.9), 2.8 (0.1-63.3), 0.9 (0.8-0.9), 88.9% (56.5-98.0), and 28.3% (17.9-41.6); PF - 11.6% (6.0-21.3), 88% (70.0-95.8), 0.9 (0.08-12.0), 1.0 (0.9-1.1), 72.7% (43.4-90.1), and 26.6% (18.2-36.9). Sensitivity increased with a CD4 ≤ 100 cells/mm(3) from 3.5% to 50% (p < 0.001) for urinary LAM ELISA; for urinary LAM strip test, grade 1 and 2 cut-points performed similarly, irrespective of HIV status or CD4 count. For PF LAM strip tests, switching cut-points from grade 1 to 2 significantly reduced test sensitivity (54.5% versus 19.7%; p < 0.001). Urinary and PF LAM assays have low sensitivity but high specificity for diagnosis of TBP. The sensitivity of urinary LAM is increased in HIV-infected patients with a CD4 ≤ 100 cells/mm(3).

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Figures

Figure 1
Figure 1. Screening, recruitment and diagnostic classification.
Figure 2
Figure 2
(a) Pre-January 2014 LAM strip test manufacturer’s reference card illustrating visual intensity grades 0–5; (b) January 2014 new LAM strip test manufacturer’s reference card illustrating visual intensity grades 0–4. In this reference card the first positive band corresponds to the grade-2 intensity band in the old, pre-January 2014 reference card. Permission granted by Alere to publish this figure.
See this image and copyright information in PMC

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