Diagnostic accuracy of nucleic acid amplification based assays for tuberculous meningitis: A meta-analysis. Issue 4 (October 2018)

• Record Type: Journal Article
• Authors: Gupta, Renu; Talwar, Puneet; Talwar, Pumanshi; Khurana, Sarbjeet; Kushwaha, Suman; Jalan, Nupur; Thakur, Rajeev
• Is Part Of: Journal of infection. Volume 77:Issue 4(2018)
• Page Start: 302
• Page End: 313
• Publication Date: 2018-10
• Subjects: Tuberculous meningitis -- Gene targets -- M. tuberculosis -- Nucleic Acid Amplification Tests -- Diagnostic accuracy -- GeneXpert; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2018.04.017
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: In-house and commercial NAAT evaluated against confirmed and suspected TBM. Strict inclusion criteria used to reduce bias. Identified potential role of In-house NAAT particularly MPB based assays. Revealed better diagnostic accuracy for commercial assays from previous reports. Identified role of GeneXpert as commercial assay. Summary: Background: Numerous in-house and commercial nucleic acid amplification tests (NAAT) have been evaluated using variable reference standards for diagnosis of TBM but their diagnostic potential is still not very clear. Methods: We conducted a meta-analysis to assess the diagnostic accuracy of different NAAT based assays for diagnosing TBM against 43 data sets of confirmed TBM ( n = 1066) and 61 data sets of suspected TBM ( n = 3721) as two reference standards. The summary estimate of the sensitivity and the specificity were obtained using the bivariate model. QUADAS-2 tool was used to perform the Quality assessment for bias and applicability. Publication bias was assessed with Deeks' funnel plot. Results: Studies with confirmed TBM had better summary estimates as compared to studies with clinically suspected TBM irrespective of NAAT and index tests used. Among in-house assays, MPB as the gene target had best summary estimates in both confirmed [sensitivity:90%(83–95), specificity:97-%(87–99), DOR:247 (50–1221), AUC:99%(97–100), PLR:38.8-(6.6–133), NLR:0.11(0.05–0.18), I 2 = 15%] and clinically suspected [sensitivity:69%(47–85), specificity:96%(90–98), DOR:62(16.8–232), AUC:94%(92–97), PLR:16.9(6.5–36.8), NLR:0.33(0.16–0.56), I 2 :15.3%] groups. GeneXpert revealed good diagnostic accuracy only in confirmed TBM group [sensitivity = 57%(38–74), specificity = 98%(89–100), DOR = 62(7–589), AUC = 87%(79–96), PLR = 33.2(3.8–128), NLR = 0.45(0.26–0.68), I 2 = 0%]. Conclusions: This meta-analysis identified potential role of MPB gene among in-house assays and GeneXpert as commercial assay for diagnosing TBM.