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For: Veroniki AA, Tsokani S, Rücker G, Mavridis D, Takwoingi Y. Challenges in Comparative Meta-Analysis of the Accuracy of Multiple Diagnostic Tests. Methods Mol Biol 2022;2345:299-316. [PMID: 34550598 DOI: 10.1007/978-1-0716-1566-9_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]

For:	Veroniki AA, Tsokani S, Rücker G, Mavridis D, Takwoingi Y. Challenges in Comparative Meta-Analysis of the Accuracy of Multiple Diagnostic Tests. Methods Mol Biol 2022;2345:299-316. [PMID: 34550598 DOI: 10.1007/978-1-0716-1566-9_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]

Number

Cited by Other Article(s)

Cheung HHT, Joynt GM, Lee A. Diagnostic test accuracy of preoperative nutritional screening tools in adults for malnutrition: a systematic review and network meta-analysis. Int J Surg 2024;110:1090-1098. [PMID: 37830947 PMCID: PMC10871615 DOI: 10.1097/js9.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]

Abstract

BACKGROUND

Good nutritional screening tests can triage malnourished patients for further assessment and management by dietitians before surgery to reduce the risk of postoperative complications. The authors assessed the diagnostic test accuracy of common nutritional screening tools for preoperative malnutrition in adults undergoing surgery and determined which test had the highest accuracy.

METHODS

MEDLINE, EMBASE, CINAHL, and Web of Science were searched for relevant titles with no language restriction from inception till 1 January 2023. Studies reporting on the diagnostic test accuracy of preoperative malnutrition in adults using one or more of the following index nutritional screening tools were included: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), short-form Mini Nutritional Assessment (MNA-SF), Nutritional Risk Index (NRI), Nutrition Risk Screening Tool 2002 (NRS-2002), and Preoperative Nutrition Screening (PONS). The reference standard was the Subjective Global Assessment (SGA) before surgery. Random-effects bivariate binomial model meta-analyses, meta-regressions, and a network meta-analysis were used to estimate the pooled and relative sensitivities and specificities.

RESULTS

Of the 16 included studies (5695 participants with an 11 957 index and 11 957 SGA tests), all were conducted after hospital admission before surgery. Eleven studies ( n =3896) were at high risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool due to a lack of blinded assessments. MUST had the highest overall test accuracy performance (sensitivity 86%, 95% CI: 75-93%; specificity 89%, 95% CI: 83-93%). Network meta-analysis showed NRI had similar relative sensitivity (0.93, 95% CI: 0.77-1.13) but lower relative specificity (0.75, 95% CI: 0.61-0.92) than MUST.

CONCLUSIONS

Of all easy-to-use tests applicable at the bedside, MUST had the highest test accuracy performance for screening preoperative malnutrition. However, its predictive accuracy is likely insufficient to justify the application of nutritional optimization interventions without additional assessments.

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Shi H, Zhang W, Zhang L, Zheng Y, Dong T. Comparison of different predictive biomarker testing assays for PD-1/PD-L1 checkpoint inhibitors response: a systematic review and network meta-analysis. Front Immunol 2023;14:1265202. [PMID: 37822932 PMCID: PMC10562577 DOI: 10.3389/fimmu.2023.1265202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open

Abstract

Background

Accurate prediction of efficacy of programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) checkpoint inhibitors is of critical importance. To address this issue, a network meta-analysis (NMA) comparing existing common measurements for curative effect of PD-1/PD-L1 monotherapy was conducted.

Methods

We searched PubMed, Embase, the Cochrane Library database, and relevant clinical trials to find out studies published before Feb 22, 2023 that use PD-L1 immunohistochemistry (IHC), tumor mutational burden (TMB), gene expression profiling (GEP), microsatellite instability (MSI), multiplex IHC/immunofluorescence (mIHC/IF), other immunohistochemistry and hematoxylin-eosin staining (other IHC&HE) and combined assays to determine objective response rates to anti-PD-1/PD-L1 monotherapy. Study-level data were extracted from the published studies. The primary goal of this study was to evaluate the predictive efficacy and rank these assays mainly by NMA, and the second objective was to compare them in subgroup analyses. Heterogeneity, quality assessment, and result validation were also conducted by meta-analysis.

Findings

144 diagnostic index tests in 49 studies covering 5322 patients were eligible for inclusion. mIHC/IF exhibited highest sensitivity (0.76, 95% CI: 0.57-0.89), the second diagnostic odds ratio (DOR) (5.09, 95% CI: 1.35-13.90), and the second superiority index (2.86). MSI had highest specificity (0.90, 95% CI: 0.85-0.94), and DOR (6.79, 95% CI: 3.48-11.91), especially in gastrointestinal tumors. Subgroup analyses by tumor types found that mIHC/IF, and other IHC&HE demonstrated high predictive efficacy for non-small cell lung cancer (NSCLC), while PD-L1 IHC and MSI were highly efficacious in predicting the effectiveness in gastrointestinal tumors. When PD-L1 IHC was combined with TMB, the sensitivity (0.89, 95% CI: 0.82-0.94) was noticeably improved revealed by meta-analysis in all studies.

Interpretation

Considering statistical results of NMA and clinical applicability, mIHC/IF appeared to have superior performance in predicting response to anti PD-1/PD-L1 therapy. Combined assays could further improve the predictive efficacy. Prospective clinical trials involving a wider range of tumor types are needed to establish a definitive gold standard in future.

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Frank RA, Salameh JP, Islam N, Yang B, Murad MH, Mustafa R, Leeflang M, Bossuyt PM, Takwoingi Y, Whiting P, Dawit H, Kang SK, Ebrahimzadeh S, Levis B, Hutton B, McInnes MDF. How to Critically Appraise and Interpret Systematic Reviews and Meta-Analyses of Diagnostic Accuracy: A User Guide. Radiology 2023;307:e221437. [PMID: 36916896 PMCID: PMC10140638 DOI: 10.1148/radiol.221437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 03/16/2023]

Affiliation(s)

Robert A. Frank
Jean-Paul Salameh
Nayaar Islam From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Bada Yang From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Mohammad Hassan Murad From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Reem Mustafa From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Mariska Leeflang From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Patrick M. Bossuyt From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Yemisi Takwoingi From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Penny Whiting From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Haben Dawit From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Stella K. Kang From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Sanam Ebrahimzadeh From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Brooke Levis From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Brian Hutton From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)
Matthew D. F. McInnes From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.)

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Duong KNC, Tan CJ, Rattanasiri S, Thakkinstian A, Anothaisintawee T, Chaiyakunapruk N. Comparison of diagnostic accuracy for diabetes diagnosis: A systematic review and network meta-analysis. Front Med (Lausanne) 2023;10:1016381. [PMID: 36760402 PMCID: PMC9902703 DOI: 10.3389/fmed.2023.1016381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open

Abstract

Aim

Fasting Plasma Glucose (FPG) and Hemoglobin A1c (HbA1c) are used as diagnostic tests for diagnosing diabetes mellitus, but it is unclear which test has the best diagnostic accuracy. This systematic review and network meta-analysis aimed to estimate the diagnostic accuracy of HbA1c ≥ 6.5%, FPG ≥ 126 mg/dl, and the combination of HbA1c ≥ 6.5% or FPG ≥ 126 mg/dl (HbA1c| FPG), compared with Oral Glucose Tolerance Test (OGTT) ≥ 200 mg/dl for diagnosis diabetes.

Materials and methods

We performed a comprehensive search in PubMed, Embase, Cochrane Library, and Scopus from inception to September 24th, 2021. Inclusion criteria were any study design comparing HbA1c ≥ 6.5%, FPG ≥ 126 mg/dl, and HbA1c ≥ 6.5% or FPG ≥ 126 mg/dl with OGTT ≥ 200 mg/dl as the reference test. Data were independently extracted, risk of bias was assessed using QUADAS-2 by two reviewers. Network meta-analysis was done using a bivariate regression model using the Bayesian framework. The relative ranking of all tests was also assessed.

Results

Out of 5,026 studies, 73 were included. The sensitivities of HbA1c, FPG, and HbA1c| FPG were 0.51 [95% Credible Interval (CrI): 0.43, 0.58], 0.49 (95% CrI: 0.43, 0.55), and 0.64 (95% CrI: 0.51, 0.75), while the specificities were 0.96 (95% CrI: 0.94, 0.97), 0.98 (95% CrI: 0.97, 0.98), and 0.95 (95% CrI: 0.88, 0.98), respectively. The corresponding positive likelihood ratios (LR) were 13.36 (95% CrI: 8.91, 20.72), 21.94 (95% CrI: 15.04, 31.88), and 11.78 (95% CrI: 5.48, 26.56). HbA1c| FPG is superior based on sensitivity, whereas FPG is ranked best based on specificity and positive LR.

Conclusion

Our findings suggest that FPG ≥ 126 mg/dl should be recommended as the best diagnostic test for diabetes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42021282856.

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Veroniki AA, Tsokani S, Agarwal R, Pagkalidou E, Rücker G, Mavridis D, Takwoingi Y. Diagnostic test accuracy network meta-analysis methods: A scoping review and empirical assessment. J Clin Epidemiol 2022;146:86-96. [PMID: 35181490 DOI: 10.1016/j.jclinepi.2022.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]