Brief Report: Real-world performance and interobserver agreement of urine lipoarabinomannan in diagnosing HIV-associated tuberculosis in an emergency center

Brief Report: Real-world performance and interobserver agreement of urine lipoarabinomannan in diagnosing HIV-associated tuberculosis in an emergency center. van Hoving, D. J, Lahri, S., Lategan, H. J, Nicol, M. P, Maartens, G., & Meintjes, G. A JAIDS Journal of Acquired Immune Deficiency Syndromes, 81(1):e10–e14, may, 2019.

Paper doi abstract bibtex

Background: The urine lipoarabinomannan (LAM) lateral flow assay is a point-of-care test to diagnose HIV-associated tuberculosis (TB). We assessed the performance of urine LAM in HIV-positive patients presenting to the emergency center and evaluated the interobserver agreement between emergency center physicians and laboratory technologists. Setting: A cross-sectional diagnostic study was performed at the emergency center of a district hospital in a high HIV-prevalence community in South Africa. Methods: Consecutive HIV-positive adults presenting with ≥1 WHO TB symptom were enrolled over a 16-month period. A urine LAM test was performed at point-of-care by an emergency physician and interpreted independently by 2 physicians. A second test was performed in the laboratory and interpreted independently by 2 laboratory technologists. The reference standard was a positive TB culture or Xpert MTB/RIF test on sputum or appropriate extrapulmonary samples. We compared diagnostic accuracy and reproducibility of urine LAM between point-of-care readers and laboratory readers. Results: One thousand three hundred eighty-eight samples (median, 3 samples/participant) were sent for TB microbiology tests in 411 participants; 170 had confirmed TB (41.4%). Point-of-care and laboratory-performed urine LAM had similar sensitivity (41.8% vs 42.0%, P = 1.0) and specificity (90.5% vs 87.5%, P = 0.23). Moderate agreement was found between point-of-care and laboratory testing ($κ$ = 0.62), but there was strong agreement between point-of-care readers ($κ$ = 0.95) and between laboratory readers ($κ$ = 0.94). Positive percent agreement between point-of-care and laboratory readers was 68% and negative percent agreement 92%. Conclusion: There is no diagnostic accuracy advantage in laboratory-performed versus point-of-care–performed urine LAM tests in emergency care centers in high-burden settings.

@article{VanHoving2019,
abstract = {Background: The urine lipoarabinomannan (LAM) lateral flow assay is a point-of-care test to diagnose HIV-associated tuberculosis (TB). We assessed the performance of urine LAM in HIV-positive patients presenting to the emergency center and evaluated the interobserver agreement between emergency center physicians and laboratory technologists. Setting: A cross-sectional diagnostic study was performed at the emergency center of a district hospital in a high HIV-prevalence community in South Africa. Methods: Consecutive HIV-positive adults presenting with ≥1 WHO TB symptom were enrolled over a 16-month period. A urine LAM test was performed at point-of-care by an emergency physician and interpreted independently by 2 physicians. A second test was performed in the laboratory and interpreted independently by 2 laboratory technologists. The reference standard was a positive TB culture or Xpert MTB/RIF test on sputum or appropriate extrapulmonary samples. We compared diagnostic accuracy and reproducibility of urine LAM between point-of-care readers and laboratory readers. Results: One thousand three hundred eighty-eight samples (median, 3 samples/participant) were sent for TB microbiology tests in 411 participants; 170 had confirmed TB (41.4{\%}). Point-of-care and laboratory-performed urine LAM had similar sensitivity (41.8{\%} vs 42.0{\%}, P = 1.0) and specificity (90.5{\%} vs 87.5{\%}, P = 0.23). Moderate agreement was found between point-of-care and laboratory testing ($\kappa$ = 0.62), but there was strong agreement between point-of-care readers ($\kappa$ = 0.95) and between laboratory readers ($\kappa$ = 0.94). Positive percent agreement between point-of-care and laboratory readers was 68{\%} and negative percent agreement 92{\%}. Conclusion: There is no diagnostic accuracy advantage in laboratory-performed versus point-of-care–performed urine LAM tests in emergency care centers in high-burden settings.},
author = {van Hoving, Dani{\"{e}}l J and Lahri, Saʼad and Lategan, Hendrick J and Nicol, Mark P and Maartens, Gary and Meintjes, Graeme A},
doi = {10.1097/QAI.0000000000002002},
issn = {1525-4135},
journal = {JAIDS Journal of Acquired Immune Deficiency Syndromes},
keywords = {fund{\_}ack,original},
mendeley-tags = {fund{\_}ack,original},
month = {may},
number = {1},
pages = {e10--e14},
pmid = {30865176},
title = {{Brief Report: Real-world performance and interobserver agreement of urine lipoarabinomannan in diagnosing HIV-associated tuberculosis in an emergency center}},
url = {http://insights.ovid.com/crossref?an=00126334-201905010-00019},
volume = {81},
year = {2019}
}

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Methods: Consecutive HIV-positive adults presenting with ≥1 WHO TB symptom were enrolled over a 16-month period. A urine LAM test was performed at point-of-care by an emergency physician and interpreted independently by 2 physicians. A second test was performed in the laboratory and interpreted independently by 2 laboratory technologists. The reference standard was a positive TB culture or Xpert MTB/RIF test on sputum or appropriate extrapulmonary samples. We compared diagnostic accuracy and reproducibility of urine LAM between point-of-care readers and laboratory readers. Results: One thousand three hundred eighty-eight samples (median, 3 samples/participant) were sent for TB microbiology tests in 411 participants; 170 had confirmed TB (41.4%). Point-of-care and laboratory-performed urine LAM had similar sensitivity (41.8% vs 42.0%, P = 1.0) and specificity (90.5% vs 87.5%, P = 0.23). Moderate agreement was found between point-of-care and laboratory testing ($κ$ = 0.62), but there was strong agreement between point-of-care readers ($κ$ = 0.95) and between laboratory readers ($κ$ = 0.94). Positive percent agreement between point-of-care and laboratory readers was 68% and negative percent agreement 92%. 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