Utility of serum galactomannan in diagnosing invasive aspergillosis among hematology patients: a meta-analysis

Abstract

Objective: In immunocompromised patients, invasive aspergillosis (IA) is a leading cause of morbidity and mortality. The serum galactomannan (GM) assay is a non-invasive test that may assist in IA diagnosis. The purpose of this meta-analysis is to determine the diagnostic accuracy of the serum GM in patients with hematological malignancies.

Materials and Methods: A search was conducted in the MEDLINE database through PubMed. After selection process and data extraction, 2x2 tables were constructed for patients with proven/probable IA and no IA, as well as for patients with proven IA and no IA. The pooled sensitivity and specificity were established using meta-analysis for the cut-off values of 0.5,1.0 and 1.5 ODI. Inter-study heterogeneity was assessed utilizing the inconsistency test (I²). The receiver operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was calculated. The data analysis was conducted using the Meta-DiSc 1.4 software.

Results: A total of 26 articles, 4502 patients and controls, together with 4761 IA episodes, were included in the meta-analysis. The total number of patients with proven and probable IA was 633 (13.3%). In the group with proven/probable IA versus no-IA, the overall pooled sensitivity and specificity were 80% and 78% (AUC: 0.892) for 0.5 ODI, 74% and 96% (AUC: 0.959) for 1.0 ODI, and 70% and 96% (AUC: 0.964) for 1.5 ODI, respectively. In the group with proven versus no-IA, the overall pooled sensitivity and specificity were 94% and 76% (AUC: 0.922) for 0.5 ODI, 86% and 96% (AUC: 0.979) for 1.0 ODI and 70% and 96% (AUC: 0.974) for 1.5 ODI, respectively.

Conclusion: Our findings indicate that the most appropriate cut-off value for Serum GM in diagnosing IA is 1.0 ODI.