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Table 3 Summary estimates of sensitivity and specificity for all case-definitions, derived from a hierarchical summary ROC model. The results may be different from those in the main text, as here they are specified for immunoblots and ELISAs and for commercial and in-house tests separately, while in the main text the overall estimates are provided

From: The diagnostic accuracy of serological tests for Lyme borreliosis in Europe: a systematic review and meta-analysis

Case definition

Assay

Design

N (studies); N(2×2 tables); N(cases); N(controls)

Sensitivity (95 % CI)

Specificity (95 % CI)

Heterogeneity

Quality and Study Design

Erythema migrans

In-house ELISA

Case-control, Healthy controls

6, 10, 451, 658

0•41 (0•25 to 0•60)

0•97 (0•95 to 0•98)

IgG lower sensitivity than IgM. Other sources of heterogeneity were not found.

Study quality did not influence the accuracy

In-house IB

3, 3, 182, 380

0•52 (0•38 to 0•65)

0•98 (0•94 to 0•99)

Commercial ELISA

13, 32, 874, 2509

0•54 (0•44 to 0•65)

0•93 (0•90 to 0•95)

Commercial IB

3, 5, 161, 289

0•58 (0•49 to 0•67)

0•86 (0•75 to 0•93)

Two-tiered tests

2, 7, 125, 190

range 0•12 to 0•64

range 0•67 to 0•96

Lyme neuroborreliosis

In-house ELISA

Case-control, Healthy controls

6, 9, 277, 649

0•69 (0•60 to 0•76)

0•88 (0•72 to 0•97)

IgM and IgG have similar sensitivity and specificity, IgG has a higher accuracy. Recombinant tests perform best. More recent studies perform better than earlier studies.

If serology was not part of the reference standard, then specificity was lower.

(serum)

In-house IB

5, 8, 253, 445

0•69 (0•57 to 0•80)

0•93 (0•86 to 0•97)

Commercial ELISA

11, 28, 484, 2920

0•81 (0•70 to 0•89)

0•94 (0•91 to 0•96)

Commercial IB

2, 4, 33, 286

0•81 (0•57 to 0•94)

0•92 (0•88 to 0•95)

 

Two-tiered tests

1, 5, 15, 100

range 0•41 to 0•87

range 0•88 to 0•94

(csf)

Any ELISA

Case-control, Cross-reacting controls

6, 9, 385, 261

0•74 (0•38 to 0•93)

0•96 (0•85 to 0•99)

(serum + csf)

Specific AI test

7, 10, 458, 380

0•86 (0•63 to 0•95)

0•94 (0•85 to 0•97)

Lyme neuroborreliosis

Any ELISA or IB (in serum)

Cross-sectional study

6, 12, 282, 412

0•78 (0•53 to 0•92)

0•78 (0•40 to 0•95)

Sensitivity similar for IgG and IgM; specifcity higher for IgG. No other sources of heterogeneity.

 

Specific AI test (in serum and CSF)

4, 4, 102, 118

0•79 (0•34 to 0•97)

0•96 (0•64 to 1•00)

Lyme arthritis

All ELISA

Case-control, Healthy controls

8, 26, 160, 1112

Median0•96

Interquartile range 0•93 to 1•00

Median 0•94

Interquartile range 0•91 to 0•97

IgM a much lower sensitivity than IgG. No other sources of heterogeneity.

Study quality did not influence the accuracy

Acrodermatitis

All ELISA

Case-control, Healthy controls

10, 27, 256, 1415

0•97 (0•94 to 0•99)

0•95 (0•88 to 0•98)

IgM a much lower sensitivity than IgG. No other sources of heterogeneity.

Study quality did not influence the accuracy

Lyme borreliosis (unspecified)

In-house ELISA

Case-control, Healthy controls

4, 7, 115, 215

0•85 (0•71 to 0•93)

0•98 (0•93 to 0•99)

Tests assessing both IgM and IgG have highest sensitivity; specificity not very variable. Recombinant tests and more recent studies perform worse.

If serology was not part of the reference standard, then accuracy was lower.

In-house IB

2, 4, 98, 126

0•63 (0•33 to 0•86)

0•97 (0•93 to 0•99)

Commercial ELISA

10, 43, 658, 815

0•70 (0•52 to 0•83)

0•95 (0•89 to 0•98)

Commercial IB

1, 4, 26, 62

0•29 (0•07 to 0•68)

0•96 (0•90 to 0•98)

Lyme borreliosis (unspecified)

Any ELISA or IB

Cross-sectional study

5, 14, 226, 914

0•77 (0•48 to 0•93)

0•77 (0•46 to 0•93)

IgM lowest sensitivity, but highest specificity; no other sources investigated.

 
  1. Number of studies is for each combination of case definition and assay category. Thus the same study may appear more than once. ELISA Enzyme Immuno Assay, IB Immunoblot, AI Antibody Index, CSF Cerebrospinal Fluid