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Rupprecht, Tobias Armin; Manz, Kirsi Marjaana ORCID: 0000-0002-7740-4076; Fingerle, Volker; Lechner, Christian; Klein, Matthias; Pfirrmann, Markus; Koedel, Uwe (2018): Diagnostic value of cerebrospinal fluid CXCL13 for acute Lyme neuroborreliosis. A systemic review and meta-analysis. In: Clinical Microbiology and infection
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Abstract

OBJECTIVES The utility of cerebrospinal fluid (CSF) CXCL13 for diagnosis of acute Lyme neuroborreliosis (LNB) has been debated and the test is not yet routinely performed. This study's aim was to evaluate its overall diagnostic accuracy through meta-analysis. METHODS Electronic searches in PubMed MEDLINE and Web of Science were performed to identify relevant articles published before January 2018. A summary receiver operating characteristic curve and an optimal cut-off were estimated modeling multiple cut-offs. Publication bias was evaluated using a funnel plot and the associated regression test. RESULTS A total of 18 studies involving 618 patients with acute LNB and 2326 patients with other neurological disorders meeting the eligibility criteria were identified. The pooled sensitivity for CSF CXCL13 was 89% (95% confidence interval (CI): 85%-93%) and the pooled specificity was 96% (95% CI: 92%-98%), using the identified optimal cut-off value of 162 pg/mL. There was marked heterogeneity between studies, caused by differences in the designs of the study populations and age distribution. The optimal cut-off in the seven studies with a cross-sectional design was 91 pg/mL (sensitivity: 96% (95% CI: 92%-98%); specificity: 94% (95% CI: 86%-97%)) and 164 pg/mL in the 11 case-control studies (sensitivity: 85% (95% CI: 78%-91%)); specificity: 95% (95% CI: 90%-98%)). CSF CXCL13 values above the optimal cut-off level (determined in this meta-analysis) were also detectable in some other CNS disorders, namely neurosyphilis and CNS-lymphoma. CONCLUSIONS Our meta-analysis shows that CSF CXCL13 has the potential to become a useful adjunct in the diagnosis of acute LNB.