Evaluación diagnóstica de las técnicas rápidas del esputo frente a neumococo en la neumonía adquirida en la comunidad. Utilización del teorema de Bayes para su aplicación clínica

Menéndez Villanueva, R.

doi:10.1016/S0300-2896(15)30895-4

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El presente trabajo tiene por objeto cuantificar el valor diagnóstico de las técnicas inmunológicas o rápidas del esputo frente al neumococo, utilizando la sensibilidad y especificidad obtenidas en la literatura, para calcular sus valores predictivos positivo (VPP) y negativo (VPN) mediante las fórmulas de Bayes. De esta forma se calculan y comparan las ganancias diagnósticas de estas pruebas a diferentes probabilidades pretest. Con este fin, se realiza una revisión bibliográfica, mediante un MEDLINE, para extraer de los artículos la sensibilidad y especificidad de la contrainmunoelectroforesis (CIE), la coaglutinación (CoA) y aglutinación por látex (AL). Se calcula además la razón de probabilidad de los tres tests. Los resultados fueron: la mayor ganancia diagnóstica global se obtiene con la AL, el mayor incremento en el VPP lo proporciona la CoA, y el mayor incremento en el VPN la AL. La CIE es el test que ofrece menor ganancia diagnóstica. Estos tres tests son más rentables para prevalencias de neumococo intermedias que coinciden con las estimadas en nuestra población. Como conclusión la AL y la CoA incrementan la ganancia diagnóstica del neumococo en la neumonía adquirida en la comunidad (NAC) lo que es útil tanto para conocer la prevalencia del neumococo en nuestro medio como para decidir el tratamiento antibiótico inicial.

Palabras clave:

Neumonía

Neumococo

Contrainmunoelectroforesis

Coaglutinación

Aglutinación por látex

Esputo

This study aimed to quantify the diagnostic value of immunological techniques and methods for rapid analysis of sputum for pneumococcus, using sensitivity and specificity values reported in the literature to calculate positive and negative predictive valúes (PPV and NPV) according to Bayes formulas. Diagnostic gains of the test are calculated and compared to pretext probability. We lorated articles reporting sensitivity and specificity of counterimmunoelectrophoresis (CIE), coagglutination (CoA) and latex agglutination (LA) tests. We also calculated the probability ratios for the three tests. LA achieved the best overall diagnostic utility rating. CoA had the highest PPV, whereas LA offered the highest NPV. CIE was the least useful. These three tests are more useful at intermedíate levels of prevalence of pneumococcus, wich coincide with estímate in our population. We conclude that LA and CoA are of greater diagnostic utility for community acquired pneumonía, as they are useful for determining prevalence as well as for deciding initial antibiotic treatment.

Key words:

Pneumonia

Pneumococcus

Counterimmun trophoresis

Coagglutination

Latex agglutination

Sput

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