Diagnostic performance of mycological tests for invasive pulmonary aspergillosis in non-haematological patients: protocol for a systematic review and meta-analysis

Abstract

Introduction: Increasing numbers of patients with non-haematological diseases are infected with invasive pulmonary aspergillosis (IPA), with a high mortality reported which is mainly due to delayed diagnosis. The diagnostic capability of mycological tests for IPA including galactomannan test, (1,3)-β-D-glucan test, lateral flow assay, lateral flow device and PCR for the non-haematological patients remains unknown. This protocol aims to conduct a systematic review and meta-analysis of the diagnostic performance of mycological tests to facilitate the early diagnosis and treatments of IPA in non-haematological diseases.

Methods and analysis: Database including PubMed, CENTRAL and EMBASE will be searched from 2002 until the publication of results. Cohort or cross-sectional studies that assessing the diagnostic capability of mycological tests for IPA in patients with non-haematological diseases will be included. The true-positive, false-positive, true-negative and false-negative of each test will be extracted and pooled in bivariate random-effects model, by which the sensitivity and specificity will be calculated with 95% CI. The second outcomes will include positive (negative) likelihood ratio, area under the receiver operating characteristic curve and diagnostic OR will also be computed in the bivariate model. When applicable, subgroup analysis will be performed with several prespecified covariates to explore potential sources of heterogeneity. Factors that may impact the diagnostic effects of mycological tests will be examined by sensitivity analysis. The risk of bias will be appraised by the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2).

Ethics and dissemination: This protocol is not involved with ethics approval, and the results will be peer-reviewed and disseminated on a recognised journal.

Prospero registration number: CRD42021241820.

Keywords: Diagnostic microbiology; Respiratory infections; THORACIC MEDICINE.

Figure 1

Flow diagram of literature selection. IPA, invasive pulmonary aspergillosis.

Figure 2

Mycological tests using differents sample types for the diagnosis of invasive pulmonary aspergillosis. BAL, bronchoalveolar lavage fluid; GM, galactomannan; BDG, (1,3)-β-D-glucan; LFA, lateral flow assay; LFD, lateral flow device; TAFC/bmGT, triacetylfusarinine C or bis(methylthio)gliotoxin.