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Table 2 Studies comparing index test to a microbiological reference standard

From: Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care

References Study population Index test Reference test Results (95% confidence interval where available)
Country n =  Mean age M:F ratio
Albert et al. [57] Canada 705 58.9 2.9 Gram stain of either ETA or BAL same sample (ETA or BAL) positive culture result for pathogenic bacteria any quantity Sens = 74%
Spec = 72%
κ = 0.36 (0.31–0.40)
Anand et al. [56] USA 105 51.5 1.4 sTREM-1 ELISA in BAL BAL culture > 103 CFU/mL Sens = 42.1%
Spec = 75.6%
Baldesi et al. [55] France 127 62.5 2.3 BAL culture > 104 CFU/mL (uncorrected for dilution factor) BAL culture > 104 CFU/mL (corrected for dilution factor using plasma/BAL urea) Sens = 97.7%
Spec = 98%
Carvalho et al. [54] Brazil 22 59.41   comparison of three sampling techniques (ETA, miniBAL, and BAL) No mention which is considered index test or reference standard Sens = NR
Spec = NR
Clavel et al. [51] France 120 65 3.1 qPCR from BAL equivalent to > 104 CFU/mL and qPCR from ETA equivalent to > 106 CFU/mL BAL culture > 104 CFU/mL or ETA culture > 106 CFU/mL qPCR from BAL
Sens = 89.2%
Spec = 97.1%
qPCR from ETA
Sens = 71.8%
Spec = 96.6%
Conway Morris et al. [74] UK 72 57 1.5 BAL IL-1β and IL-8 BAL culture > 104 CFU/mL Sens = 94%
Spec = 64%
Douglas et al. [50] USA 33 55 N/R Mini BAL automated microscopy Mini BAL culture > 104 CFU/mL Sens = 100%
Spec = 97%
Elmahalawy et al. [49] Egypt 40 45.4 3.0 Pentraxin 3 ELISA in BAL BAL culture > 104 CFU/mL Sens = 96.7%
Spec = 100%
AUROCC = 0.966 (0.985 to 1)
Fujitani et al. [47] USA 256 57.5 2.1 ETA culture Mini BAL culture > 104 CFU/mL Sens = 65.4%
Spec = 56.1%
κ = 0.22 (0.17–0.27)
Gedik et al. [46] Turkey 31 56 1.4 ETA culture > 105 CFU/mL Mini BAL culture > 104 CFU/mL κ = 0.804, p = 0.005
Goldberg et al. [45] USA 229 49 2.0 Gram stain of BAL BAL culture > 105 CFU/mL Sens = 90%
Spec = 67%
Guler et al. [43] Turkey 50 52 2.1 Modified CPIS BAL culture > 104 CFU/mL CPIS > 7
Sens = 80%
Spec = 17%
CPIS > 6
Sens = 76%
Spec = 15%
CPIS ≥ 6
Sens = 80.7%
Spec = 16.6%
CPIS ≥ 5
Sens = 80%
Spec = 10%
Hashimoto et al. [42] Japan 51 41 1.4 Semi-quantitative Gram stain or culture of ETA or BAL (not otherwise specified) ETA culture > 106 CFU/mL Gram stain
Sens = 95%
Spec = 61%
κ = 0.59 (0.45–0.72)
Culture
Sens = 96%
Spec = 40%
κ = 0.4 (0.25–0.54)
Hellyer et al. [41] UK 150 56.3 2.9 BAL IL-1β and IL-8 BAL culture > 104 CFU/mL Sens = 100%
Spec = 44.3%
Jackson et al. [40] USA 73 52 3.5 BAL—unilateral BAL—bilateral Sens = 73%
Spec = 82%
Jiao et al. [65] China 92 48 1.0 Serum PCT
Serum IL-6
Serum CRP
BAL culture > 104 CFU/mL PCT
Sens = 91%
Spec = 71%
IL-6
Sens = 58%
Spec = 64%
CRP
Sens = 52%
Spec = 74%
Jung et al. [63] France 57 61 2.2 BAL Procalcitonin BAL culture > 104 CFU/mL Sens = 94%
Spec = 75%
Kneidinger et al. [60] Austria 132 62 2.1 BAL culture > 104 CFU/mL after 24 h storage at 4 °C and after storage at − 80 °C BAL culture > 104 CFU/mL after immediate culture Immediate culture vs delayed culture (4 °C)
Sens = 96.5%
Spec = 100%
Immediate culture vs delayed culture (− 80 °C)
Sens = 50.4%
Spec = 100%
Kwon et al. [59] Korea 64 65 2.6 qPCR of BAL fluid or bronchial washings BAL culture > 104 CFU/mL or bronchial washing > 105 CFU/mL Sens = 88.9%
Spec = 88.9%
Leo et al. [58] Mexico 21 42 2.0 mini BAL (using cut NG tube) > 104 CFU/mL BAL culture > 104 CFU/mL Sens = 92.8%
Spec = 85%
Linssen et al. [67] USA 117 N/R N/R BAL PCT and CRP BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms PCT
AUCROCC = 0.448
CRP
AUCROCC = 0.477
Linssen et al. [75] USA 282 60.3 2.1 Various BAL cytological parameters including total cell count, alveolar macrophages, lymphocytes, neutrophils, eosinophils, mast cells, infected cells; in isolation or in combination BAL culture > 104 CFU/mL AUROCC for various cytological parameters
Total cell count = 0.647
Alveolar macrophages = 0.313
Lymphocytes = 0.381
Neutrophils = 0.705
Eosinophils = 0.589
Mast cells = 0.557
Infected cells (%) = 0.904
AUROCC for combinations of cytological parameters
Infected cells (%) + PMNs (%) = 0.892
Infected cells (%) + Total cell count = 0.890
Luna et al. [69] Argentina 283 71.3 1.1 ETA culture > 103 CFU/mL BAL culture > 104 CFU/mL Sens = NR
Spec = NR
Luyt et al. [70] France 41 60 2.4 serum PCT 1st day of clinical suspicion of VAP BAL culture > 104 CFU/mL Sens = 72%
Spec = 24%
Mongodi et al. [73] France 99 66 3.7 Vplus-Eagram (ventilator-associated pneumonia lung ultrasound score and gram stain of ETA) BAL culture > 104 CFU/mL Sens = 81%
Spec = 41%
Oudhuis et al. [66] Netherlands 207 62 1.7 ETA culture > 105 CFU/mL BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms Sens = 65%
Spec = 48%
Refaat et al. [76] Egypt 66 NR NR BAL composite biomarker (CRP, PCT, neutrophils, MIF, sTREM-1, suPAR) BAL culture > 10 CFU/mL Sens = 76%
Spec = 62%
Schnabel et al. [48] Netherlands 100 61.3 2.3 VOC in exhaled breath BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms Sens = 75.8%
Spec = 73.0%
Scholte et al. [77] Netherlands 311 NR NR ETA Gram stain
ETA Culture
BALF Gram stain
BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms ETA Gram stain
Sens = 65%
Spec = 72%
ETA Culture (any threshold)
Sens = 82%
Spec = 42%
BALF Gram stain (> 0)
Sens = 82%
Spec = 66%
Vanspauwen et al. [79] Netherlands 196 58.8 1.7 BAL Clara Cell protein 10 ELISA BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms AUROCC of 0.586 (0.496–0.676)
Yagmurdur et al. [82] Turkey 59 71 0.73 ETA culture > 104 CFU/mL BAL culture > 104 CFU/mL Sens = 60%
Spec = 39%
Zagli et al. [83] Italy 221 56 2.7 Chest Echography and Procalcitonin Pulmonary Infection Score > 5 ETA culture > 104 CFU/mL Sens = 80.5%
Spec = 85.2%