Supplementary Material for: Appraising the Accuracy of Ischaemia-Modified Albumin in Diagnosing Stroke: A Systematic Review and Meta-Analysis

Introduction: Ischaemia-modified albumin (IMA) is a new, sensitive marker of ischaemic diseases that has been approved for diagnosing myocardial ischaemia. However, the accuracy of IMA in the diagnosis of stroke remains to be clarified. The study’s purpose is to assess the potential role of IMA as a diagnostic indicator in stroke. Methods: We carried out a systematic search in Medline, the Cochrane Library, Embase, Scopus, Science Direct, ISI Web of Knowledge, and the reference lists of relevant articles from the databases’ inception to September 1, 2019. Studies that appraised the diagnostic accuracy of IMA for acute stroke patients were included in our study. Two reviewers extracted data independently and assessed the quality of the retrieved studies, and disagreements were resolved through discussions with a third reviewer. Sensitivities and specificities were pooled by using bivariate diagnostic meta-analysis. We calculated I2 to test the heterogeneity and used meta-regression to identify potential sources of heterogeneity. This systematic review and meta-analysis is registered in international prospective register of systematic reviews (number CRD42020149174). Results: Six studies with 605 patients were eligible for inclusion. Our meta-analysis produced the following outcomes: the mean sensitivity of IMA in diagnosing acute stroke was 0.80 (95% confidence interval [CI], 0.69–0.88) and the specificity was 0.80 (95% CI, 0.71–0.87). The area under the receiver operating characteristic curve was 0.86 (95% CI, 0.83–0.89), and the pooled diagnostic odds ratio was 16 (95% CI, 8–33). There was obvious heterogeneity between studies (I2 = 78%, 95% CI, 53–100). Sensitivity analysis and meta-regression could account for the heterogeneity. Conclusion: IMA is a helpful marker for consideration in the early diagnosis of stroke.