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Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis
Background: Tuberculous meningitis (TBM) is one of the most serious types of extrapulmonary tuberculosis. However, low sensitivity of culture of cerebrospinal fluid (CSF) increases the difficulty in clinical diagnosis, leading to diagnostic delay, and misdiagnosis. Xpert MTB/RIF assay is a rapid and...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Portland Press Ltd.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946622/ https://www.ncbi.nlm.nih.gov/pubmed/31778149 http://dx.doi.org/10.1042/BSR20191312 |
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author | Chen, Yuan-Zhi Sun, Li-Chang Wen, Yao-Hong Li, Zhong-Wei Fan, Shu-Jin Tan, Hong-Kun Qiu, Min Pan, Zhi-Yong Li, Qin Zhao, Yan-Zhen Li, Zhen-Xing Guo, Xu-Guang |
author_facet | Chen, Yuan-Zhi Sun, Li-Chang Wen, Yao-Hong Li, Zhong-Wei Fan, Shu-Jin Tan, Hong-Kun Qiu, Min Pan, Zhi-Yong Li, Qin Zhao, Yan-Zhen Li, Zhen-Xing Guo, Xu-Guang |
author_sort | Chen, Yuan-Zhi |
collection | PubMed |
description | Background: Tuberculous meningitis (TBM) is one of the most serious types of extrapulmonary tuberculosis. However, low sensitivity of culture of cerebrospinal fluid (CSF) increases the difficulty in clinical diagnosis, leading to diagnostic delay, and misdiagnosis. Xpert MTB/RIF assay is a rapid and simple method to detect tuberculosis. However, the efficacy of this technique in diagnosing TBM remains unclear. Therefore, a meta-analysis was conducted to evaluate the diagnostic efficacy of Xpert MTB/RIF for TBM, which may enhance the development of early diagnosis of TBM. Methods: Relevant studies in the PubMed, Embase, and Web of Science databases were retrieved using the keywords ‘Xpert MTB/RIF’, ‘tuberculous meningitis (TBM)’. The pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, summary receiver operator characteristic curve, and area under the curve (AUC) of Xpert MTB/RIF were determined and analyzed. Results: A total of 162 studies were enrolled and only 14 met the criteria for meta-analysis. The overall pooled sensitivity of Xpert MTB/RIF was 63% [95% confidence interval (CI), 59–66%], while the overall pooled specificity was 98.1% (95% CI, 97.5–98.5%). The pooled values of positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 20.91% (12.71–52.82%), 0.40% (0.32–0.50%), and 71.49% (32.64–156.56%), respectively. The AUC was 0.76. Conclusions: Xpert MTB/RIF exhibited high specificity in diagnosing TBM in CSF samples, but its sensitivity was relatively low. It is necessary to combine other high-sensitive detection methods for the early diagnosis of TBM. Moreover, the centrifugation of CSF samples was found to be beneficial in improving the sensitivity. |
format | Online Article Text |
id | pubmed-6946622 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Portland Press Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-69466222020-01-15 Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis Chen, Yuan-Zhi Sun, Li-Chang Wen, Yao-Hong Li, Zhong-Wei Fan, Shu-Jin Tan, Hong-Kun Qiu, Min Pan, Zhi-Yong Li, Qin Zhao, Yan-Zhen Li, Zhen-Xing Guo, Xu-Guang Biosci Rep Microbiology Background: Tuberculous meningitis (TBM) is one of the most serious types of extrapulmonary tuberculosis. However, low sensitivity of culture of cerebrospinal fluid (CSF) increases the difficulty in clinical diagnosis, leading to diagnostic delay, and misdiagnosis. Xpert MTB/RIF assay is a rapid and simple method to detect tuberculosis. However, the efficacy of this technique in diagnosing TBM remains unclear. Therefore, a meta-analysis was conducted to evaluate the diagnostic efficacy of Xpert MTB/RIF for TBM, which may enhance the development of early diagnosis of TBM. Methods: Relevant studies in the PubMed, Embase, and Web of Science databases were retrieved using the keywords ‘Xpert MTB/RIF’, ‘tuberculous meningitis (TBM)’. The pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, summary receiver operator characteristic curve, and area under the curve (AUC) of Xpert MTB/RIF were determined and analyzed. Results: A total of 162 studies were enrolled and only 14 met the criteria for meta-analysis. The overall pooled sensitivity of Xpert MTB/RIF was 63% [95% confidence interval (CI), 59–66%], while the overall pooled specificity was 98.1% (95% CI, 97.5–98.5%). The pooled values of positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 20.91% (12.71–52.82%), 0.40% (0.32–0.50%), and 71.49% (32.64–156.56%), respectively. The AUC was 0.76. Conclusions: Xpert MTB/RIF exhibited high specificity in diagnosing TBM in CSF samples, but its sensitivity was relatively low. It is necessary to combine other high-sensitive detection methods for the early diagnosis of TBM. Moreover, the centrifugation of CSF samples was found to be beneficial in improving the sensitivity. Portland Press Ltd. 2020-01-07 /pmc/articles/PMC6946622/ /pubmed/31778149 http://dx.doi.org/10.1042/BSR20191312 Text en © 2020 The Author(s). https://creativecommons.org/licenses/by/4.0/ This is an open access article published by Portland Press Limited on behalf of the Biochemical Society and distributed under the Creative Commons Attribution License 4.0 (CC BY). |
spellingShingle | Microbiology Chen, Yuan-Zhi Sun, Li-Chang Wen, Yao-Hong Li, Zhong-Wei Fan, Shu-Jin Tan, Hong-Kun Qiu, Min Pan, Zhi-Yong Li, Qin Zhao, Yan-Zhen Li, Zhen-Xing Guo, Xu-Guang Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis |
title | Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis |
title_full | Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis |
title_fullStr | Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis |
title_full_unstemmed | Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis |
title_short | Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis |
title_sort | pooled analysis of the xpert mtb/rif assay for diagnosing tuberculous meningitis |
topic | Microbiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946622/ https://www.ncbi.nlm.nih.gov/pubmed/31778149 http://dx.doi.org/10.1042/BSR20191312 |
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