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Review
. 2017 Apr 1;13(3):541-549.
doi: 10.5114/aoms.2017.67279. Epub 2017 Apr 20.

Performance of pfHRP2 versus pLDH antigen rapid diagnostic tests for the detection of Plasmodium falciparum: a systematic review and meta-analysis

Bo Li  1 , Zhiqiang Sun  1 , Xiaohan Li  1   2 , Xiaoxi Li  1 , Han Wang  1 , Weijiao Chen  1 , Peng Chen  1 , Mengran Qiao  1 , Yuanli Mao  1
Affiliations
Review

Performance of pfHRP2 versus pLDH antigen rapid diagnostic tests for the detection of Plasmodium falciparum: a systematic review and meta-analysis

Bo Li et al. Arch Med Sci. .

Abstract

Introduction: There have been many inconsistent reports about the performance of histidine-rich protein 2 (HRP2) and lactate dehydrogenase (LDH) antigens as rapid diagnostic tests (RDTs) for the diagnosis of past Plasmodium falciparum infections. This meta-analysis was performed to determine the performance of pfHRP2 versus pLDH antigen RDTs in the detection of P. falciparum.

Material and methods: After a systematic review of related studies, Meta-DiSc 1.4 software was used to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Forest plots and summary receiver operating characteristic curve (SROC) analysis were used to summarize the overall test performance.

Results: Fourteen studies which met the inclusion criteria were included in the meta-analysis. The summary performances for pfHRP2- and pLDH-based tests in the diagnosis of P. falciparum infections were as follows: pooled sensitivity, 96.3% (95.8-96.7%) vs. 82.6% (81.7-83.5%); specificity, 86.1% (85.3-86.8%) vs. 95.9% (95.4-96.3%); diagnostic odds ratio (DOR), 243.31 (97.679-606.08) vs. 230.59 (114.98-462.42); and area under ROCs, 0.9822 versus 0.9849 (all p < 0.001).

Conclusions: The two RDTs performed satisfactorily for the diagnosis of P. falciparum, but the pLDH tests had higher specificity, whereas the pfHRP2 tests had better sensitivity. The pfHRP2 tests had slightly greater accuracy compared to the pLDH tests. A combination of both antigens might be a more reliable approach for the diagnosis of malaria.

Keywords: Plasmodium falciparum; histidine-rich protein 2; lactate dehydrogenase; rapid diagnostic tests.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study selection process
Figure 2
Figure 2
A – Risk of bias and applicability concerns summary: review authors’ judgments about each domain of the QUADAS-2 checklist for each study. B – Risk of bias and applicability concerns graph: review authors’ judgments about each domain presented as percentages across included studies
Figure 3
Figure 3
Forest plot of pairs of sensitivity and specificity in each study
Figure 4
Figure 4
Summary receiver operating characteristic curves for pfHRP2- and pLDH-based tests
See this image and copyright information in PMC

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