Diagnostic value of different urine tests for urinary tract infection: a systematic review and meta-analysis

BACKGROUND: There are differences in specificity and sensitivity of different routine urine tests for urinary tract infection, so meta-analysis was used to compare the diagnostic value of various urine analysis and detection methods in urinary tract infection, including bacterial culture, urine sediment microscopy, automated urinalysis, and routine urine dry chemical methods. METHODS: The PubMed, Embase, Cochrane Library, SpringerLink, CNKI, and Wanfang databases were searched from inception to December 2021. Two system assessors independently screened the literature according to the inclusion and exclusion criteria. RevMan version 5.3 (the Cochrane Collaboration) and Meta-DiSc were used to calculate the combined sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR–), and diagnostic ratio (DOR) of the diagnostic tests and draw summary receiver operating characteristic (SROC) curves. RESULTS: A total of 14 documents were included according to the inclusion and exclusion criteria. There was a significant statistical difference between the urine sediment microscopy group and the urine normalization group in urine leucocyte detection (OR =2.15, 95% CI: 1.29–3.56, P=0.003, I(2)=19%, Z=2.95), urine erythrocyte test (OR =1.87, 95% CI: 1.13–3.09, P=0.01, I(2)=0%, Z=2.45), quantitative determination of urinary protein composition (OR =2.32, 95% CI: 1.27–4.23, P=0.006, I(2=)30%, Z=2.73), and determination of urinary enzymes (OR =1.67, 95% CI: 1.03–2.72, P=0.04, I(2=)0%, Z=2.07). DISCUSSION: When examining red and white blood cells in urinary tract infection diagnosis, urine dry chemistry is superior to automated urinalysis in terms of area under the curve (AUC), Sen, Spe, etc. When examining urine bacteria, urine dry chemistry can be recommended for urine bacteria screening, with bacterial culture required for confirmation.