Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis
Abstract Introduction The diagnosis of smear-negative pulmonary tuberculosis (SNPTB) is challenging. Interferon gamma-release assays (IGRAs) may be helpful in early diagnosis among these patients resulting in prompt treatment and favorable outcomes. Methods We performed a comprehensive search from e...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-022-02013-y |
| _version_ | 1811248064952795136 |
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| author | Tananchai Petnak Dararat Eksombatchai Supavit Chesdachai Ploypin Lertjitbanjong Pahnwat Taweesedt Angsupat Pornchai Charat Thongprayoon Larry J. Prokop Zhen Wang |
| author_facet | Tananchai Petnak Dararat Eksombatchai Supavit Chesdachai Ploypin Lertjitbanjong Pahnwat Taweesedt Angsupat Pornchai Charat Thongprayoon Larry J. Prokop Zhen Wang |
| author_sort | Tananchai Petnak |
| collection | DOAJ |
| description | Abstract Introduction The diagnosis of smear-negative pulmonary tuberculosis (SNPTB) is challenging. Interferon gamma-release assays (IGRAs) may be helpful in early diagnosis among these patients resulting in prompt treatment and favorable outcomes. Methods We performed a comprehensive search from each databases’ inception to April 5, 2021. The studies that provided sufficient data regarding the sensitivity and specificity of IGRAs included QuantiFERON-TB Gold In-Tube (QFT-GIT), T-SPOT.TB, or QuantiFERON-TB Gold Plus for diagnosis of SNPTB were included. Results Of 1,312 studies screened, 16 studies were included; 11 QFT-GIT, 2 T-SPOT.TB, and 3 QFT-GIT and T-SPOT.TB. For diagnosis of SNPTB, QFT-GIT had sensitivity of 0.77 (95% CI 0.71–0.82), specificity of 0.70 (95% CI 0.58–0.80), diagnostic odds ratio (DOR) of 8.03 (95% CI 4.51–14.31), positive likelihood ratio (LR) of 2.61 (95% CI 1.80–3.80), negative LR of 0.33 (95% CI 0.25–0.42), and area under receiver operating characteristic (AUROC) of 0.81 (95% CI 0.77–0.84). T-SPOT.TB had sensitivity of 0.74 (95% CI 0.71–0.78), specificity of 0.71 (95% CI 0.49–0.86), DOR of 6.96 (95% CI 2.31–20.98), positive LR of 2.53 (95% CI 1.26–5.07), negative LR of 0.36 (95% CI 0.24–0.55), and AUROC of 0.77 (95% CI 0.73–0.80). The specificity seemed lower in the subgroup analyses of studies from high tuberculosis burden counties compared to the studies from low tuberculosis burden. Conclusion IGRAs do have insufficient diagnostic performance for SNPTB. However, the tests are still helpful to exclude tuberculosis among patients with low pre-test probability. Registry: PROSPERO: CRD42021274653. |
| first_indexed | 2024-04-12T15:20:25Z |
| format | Article |
| id | doaj.art-427fe30f5af347308c69e5d0081b5ff8 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-12T15:20:25Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-427fe30f5af347308c69e5d0081b5ff82022-12-22T03:27:27ZengBMCBMC Pulmonary Medicine1471-24662022-06-012211910.1186/s12890-022-02013-yDiagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysisTananchai Petnak0Dararat Eksombatchai1Supavit Chesdachai2Ploypin Lertjitbanjong3Pahnwat Taweesedt4Angsupat Pornchai5Charat Thongprayoon6Larry J. Prokop7Zhen Wang8Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDivision of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDivision of Infectious Diseases, Department of Medicine, Mayo ClinicDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Tennessee Health Science CenterDepartment of Pulmonary Medicine, Corpus Christi Medical CenterDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo ClinicDivision of Nephrology and Hypertension, Department of Medicine, Mayo ClinicMayo Clinic Libraries, Mayo ClinicMayo Clinic Libraries, Mayo ClinicAbstract Introduction The diagnosis of smear-negative pulmonary tuberculosis (SNPTB) is challenging. Interferon gamma-release assays (IGRAs) may be helpful in early diagnosis among these patients resulting in prompt treatment and favorable outcomes. Methods We performed a comprehensive search from each databases’ inception to April 5, 2021. The studies that provided sufficient data regarding the sensitivity and specificity of IGRAs included QuantiFERON-TB Gold In-Tube (QFT-GIT), T-SPOT.TB, or QuantiFERON-TB Gold Plus for diagnosis of SNPTB were included. Results Of 1,312 studies screened, 16 studies were included; 11 QFT-GIT, 2 T-SPOT.TB, and 3 QFT-GIT and T-SPOT.TB. For diagnosis of SNPTB, QFT-GIT had sensitivity of 0.77 (95% CI 0.71–0.82), specificity of 0.70 (95% CI 0.58–0.80), diagnostic odds ratio (DOR) of 8.03 (95% CI 4.51–14.31), positive likelihood ratio (LR) of 2.61 (95% CI 1.80–3.80), negative LR of 0.33 (95% CI 0.25–0.42), and area under receiver operating characteristic (AUROC) of 0.81 (95% CI 0.77–0.84). T-SPOT.TB had sensitivity of 0.74 (95% CI 0.71–0.78), specificity of 0.71 (95% CI 0.49–0.86), DOR of 6.96 (95% CI 2.31–20.98), positive LR of 2.53 (95% CI 1.26–5.07), negative LR of 0.36 (95% CI 0.24–0.55), and AUROC of 0.77 (95% CI 0.73–0.80). The specificity seemed lower in the subgroup analyses of studies from high tuberculosis burden counties compared to the studies from low tuberculosis burden. Conclusion IGRAs do have insufficient diagnostic performance for SNPTB. However, the tests are still helpful to exclude tuberculosis among patients with low pre-test probability. Registry: PROSPERO: CRD42021274653.https://doi.org/10.1186/s12890-022-02013-yDiagnosisInterferon-gamma release assaysMeta-analysisSensitivitySpecificitySmear-negative |
| spellingShingle | Tananchai Petnak Dararat Eksombatchai Supavit Chesdachai Ploypin Lertjitbanjong Pahnwat Taweesedt Angsupat Pornchai Charat Thongprayoon Larry J. Prokop Zhen Wang Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis BMC Pulmonary Medicine Diagnosis Interferon-gamma release assays Meta-analysis Sensitivity Specificity Smear-negative |
| title | Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis |
| title_full | Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis |
| title_fullStr | Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis |
| title_full_unstemmed | Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis |
| title_short | Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis |
| title_sort | diagnostic accuracy of interferon gamma release assays for diagnosis of smear negative pulmonary tuberculosis a systematic review and meta analysis |
| topic | Diagnosis Interferon-gamma release assays Meta-analysis Sensitivity Specificity Smear-negative |
| url | https://doi.org/10.1186/s12890-022-02013-y |
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