Among the CLAL studies, 10 were limited to patients meeting the criteria of sepsis syndrome (SS), and this subgroup was compared with the other CLAL studies (non-SS studies).
Twenty-eight studies used the GLAL (Table 1) and 28 studies used the CLAL (Table 2).
Of the 28 CLAL studies, 10 studies[43-45,47,49,50,54,56,58] used SS criteria as the basis for patient inclusion.
The results of SROC analysis demonstrated no difference in the performance of studies using CLAL versus those using GLAL (Figure 1).
Among the CLAL studies, the results of SROC analysis demonstrated no difference in the performance of the 10 studies in which SS criteria were used for patient inclusion versus the 18 studies that did not use these criteria.
Data on the proportion of non-Enterobacteriaceae among the gram-negative bacteremia isolates were available for 45 studies (25 GLAL studies and 20 CLAL studies).
5 to 10 ng/mL and for CLAL studies, in the range of 10 to 500 pg/mL.
For example, in the comparison of CLAL and GLAL in this analysis, the findings are not altered when small studies, studies that included documented infections, studies reporting per episode data, or all 3 of these categories of studies are excluded from the analysis.
The Q* value found in this analysis for the CLAL as a predictor of gram-negative bacteremia in patients with SS is no better than that found with prediction rules based on clinical criteria.
The main finding of this meta-analysis is that the clinical utility of the LAL test would appear not to depend on whether a CLAL or GLAL version of the assay was employed.
By contrast, not only are the levels of endotoxemia in patients with sepsis at the limits of detection by the CLAL assay,[39,44,47,50] but also the plasma levels in patients with and patients without gram-negative bacteremia are similar.