GLALGerman Life and Letters (journal; Wiley)
GLALGelation of Limulus Amebocyte Lysate
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Twenty-eight studies used the GLAL (Table 1) and 28 studies used the CLAL (Table 2).
In the 18 other CLAL studies, and in all but 1 of the GLAL studies, patients had been included usually on the basis of a clinical suspicion of gram-negative bacteremia.
The results of SROC analysis demonstrated no difference in the performance of studies using CLAL versus those using GLAL (Figure 1).
Ten studies (7 GLAL and 3 (CLAL) were limited to specific infection types (plague, 2 studies[7,17]; typhoid, 4 studies[16,20,26,30] salmonellosis, 1 study[16]; meningococcal infections, 1 study[41]; and urinary tract origin of infection, 2 studies[38,51].
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).
The sensitivity limit for GLAL studies was usually in the range of 0.5 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 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.
For example, as many as 21.5% of apparently healthy elderly individuals who would not be expected to have gram-negative bacteremia have been found to have endotoxin levels close to the sensitivity limit of the CLAL assay (10 pg/mL).[73] Moreover, there are multiple interactions between the LAL assay and plasma that are complex and easily overlooked in the CLAL assay.[74] As a consequence, for plasma, any gain in TPR with the CLAL assay over that found with the GLAL assay will be offset by an increase in FPR.