Diagnostic accuracy of urinary antigen tests for legionellosis: A systematic review and meta-analysis

Takeshi Kawasaki; Natsuki Nakagawa; Maki Murata; Shunsuke Yasuo; Takuo Yoshida; Koichi Ando; Satoshi Okamori; Yohei Okada; Japanese ARDS Clinical Practice Guideline Systematic Review Task Force

doi:10.1016/j.resinv.2021.11.011

Diagnostic accuracy of urinary antigen tests for legionellosis: A systematic review and meta-analysis

Respir Investig. 2022 Mar;60(2):205-214. doi: 10.1016/j.resinv.2021.11.011. Epub 2021 Dec 28.

Authors

Takeshi Kawasaki¹, Natsuki Nakagawa², Maki Murata³, Shunsuke Yasuo⁴, Takuo Yoshida⁵, Koichi Ando⁶, Satoshi Okamori⁷, Yohei Okada⁸; Japanese ARDS Clinical Practice Guideline Systematic Review Task Force

Affiliations

¹ Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
² Department of Respiratory Medicine, Tokyo University, Tokyo, Japan. Electronic address: nnakagawautmedsle@yahoo.co.jp.
³ Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁴ Department of Emergency and Critical Care Medicine, Kyoto-Katsura Hospital, Kyoto, Japan.
⁵ Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan.
⁶ Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
⁷ Department of Medicine, Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan.
⁸ Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.

PMID: 34972680
DOI: 10.1016/j.resinv.2021.11.011

Abstract

Background: Urinary antigen tests (UATs) have been used for the early detection of legionellosis and have demonstrated moderate sensitivity and high specificity. However, the most recent systematic review and meta-analysis published in 2009 evaluated the accuracy of UATs; since then, UAT accuracy may have changed owing to advances and developments in UAT technology and epidemiological changes in the frequency of Legionella species that cause legionellosis. Therefore, this systematic review and meta-analysis aimed to update the accuracy of UATs for legionellosis among patients with suspected pneumonia.

Methods: Overall, 1326 studies were screened, 21 of which fulfilled the eligibility criteria for quality assessment and meta-analysis. Data from 5772 patients, including 1368 (23.7%) with the target condition (i.e., suspected legionellosis), were included in the analysis. The overall quality of the included studies, which was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, was unclear.

Results: The calculated pooled sensitivity and specificity were 0.79 (95% confidence interval [CI], 0.71-0.85) and 1.00 (95% CI, 0.99-1.00), respectively. Subpopulation analysis revealed that the accuracy of UATs for sensitivity and specificity for Legionella pneumophilia serogroup 1 was 0.86 (95% CI, 0.78-0.91) and 1.00 (95% CI, 0.99-1.00), respectively.

Conclusions: This study demonstrated that the sensitivity and specificity of UATs were moderate and high, respectively, which is comparable to the results reported in 2009. Therefore, UATs may be a useful method for the early detection of legionellosis caused by Legionella pneumophila serogroup 1.

Clinical trial registration: The review protocol was prospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000041080).

Keywords: Legionella; Legionellosis; Pneumonia; Systematic review and meta-analysis; Urinary antigen test.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Humans
Immunologic Tests
Legionella pneumophila*
Legionella*
Legionellosis* / diagnosis
Legionellosis* / epidemiology
Sensitivity and Specificity