Diagnostic value of computed tomography-based pulmonary artery to aorta ratio measurement in chronic obstructive pulmonary disease with pulmonary hypertension: A systematic review and meta-analysis

Objective: We conducted a meta-analysis to systematic assess the diagnostic value of computed tomography (CT)-based pulmonary artery to aorta (PA:A) ratio measurement in COPD with pulmonary hypertension (COPD-PH). Methods: Published studies referring to diagnostic accuracy of PA:A ratio for COPD-PH were screened out from PubMed, Embase, Web of science, China National Knowledge databases (CNKI), Wan fang databases, and VIP databases. We used bivariate random-effects model to estimate pooled sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR, respectively), and diagnostic odds ratios (DOR). Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were also calculated to summarize the aggregate diagnostic performance. Results: Nine eligible studies were included and the pooled SEN was 69% (95% CI: 59 similar to 78), SPE was 85% (95% CI: 77 similar to 90), PLR was 4.5 (95% CI: 2.8 similar to 7.5), and NLR was 0.36 (95% CI: 0.26 similar to 0.51), respectively. DOR reached 13.00 (95% CI: 6.00 similar to 28.00), and value of AUC was 0.84 (95% CI: 0.81 similar to 0.87). Subgroup analysis indicated that when the value of PA:A ratio was equal or greater than one (PA/A >= 1), the combined SEN, SPE, AUC, and DOR was 69%, 89%, 0.90, and 19.65, respectively. Conclusions: PA:A ratio is helpful for appraisal of COPD-PH, and PA/A = 1 possessed prominent diagnostic accuracy.