Diagnostic accuracy of the interferon-gamma release assay in acquired immunodeficiency syndrome patients with suspected tuberculosis infection: a meta-analysis

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Abstract

Purpose

The diagnostic accuracy of the interferon-gamma release assay (IGRA) in immunosuppressed patients remains unclear.

Methods

A systematic review and meta-analysis were performed for diagnostic test accuracy of IGRA in tuberculosis (TB) infection among people living with HIV (PLWHIV). Summary estimates of sensitivity and specificity were calculated using both univariate and bivariate models.

Results

The meta-analysis included 45 of the 1,242 first-screened articles. The total number of PLWHIV was 6,525; 3,467 had TB disease, including 806 cases of LTBI and 2,661 cases of active TB. The overall diagnostic odds ratio (DOR) of IGRA in the diagnosis of TB disease was 10.0 (95% confidence interval (CI) 5.59, 25.07), with an area under the curve (AUC) of 0.729. The DOR was better for QFT (14.2 (95%CI 4.359, 46.463)) than T-SPOT (10.0 (95%CI 3.866 26.033)). The sensitivity and specificity of QFT and T-SPOT were 0.663 (95%CI 0.471, 0.813), 0.867 (95%CI 0.683 0.942), and 0.604 (95%CI 0.481, 0.715), 0.862 (95%CI 0.654, 0.954), respectively, in the bivariate model. The sensitivity of IGRA in the diagnosis of LTBI was 0.64 (95%CI 0.61, 0.66).

Conclusion

IGRA was useful in the diagnostic of TB disease in PLWHIV, and QFT showed a better tendency of DOR than T-SPOT. IGRA showed a limited effect to rule out LTBI in PLWHIV.

Supplementary Information

The online version contains supplementary material available at 10.1007/s15010-022-01789-9.

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Most cited references 64

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In 2003, the QUADAS tool for systematic reviews of diagnostic accuracy studies was developed. Experience, anecdotal reports, and feedback suggested areas for improvement; therefore, QUADAS-2 was developed. This tool comprises 4 domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias, and the first 3 domains are also assessed in terms of concerns regarding applicability. Signalling questions are included to help judge risk of bias. The QUADAS-2 tool is applied in 4 phases: summarize the review question, tailor the tool and produce review-specific guidance, construct a flow diagram for the primary study, and judge bias and applicability. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.

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Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests.

Thanos Athanasiou, Hannah M Jones (2004)

The number of studies in the literature using summary receiver operating characteristic (SROC) analysis of diagnostic accuracy is rising. The SROC is useful in many such meta-analyses, but is often poorly understood by clinicians, and its use can be inappropriate. The academic literature on this topic is not always easy to comprehend. Interpretation is therefore difficult. This report aims to explain the concept of SROC analysis, its advantages, disadvantages, indications, and interpretation for the cardiothoracic surgeon. We use a practical approach to show how SROC analysis can be applied to meta-analysis of diagnostic accuracy by using a contrived dataset of studies on virtual bronchoscopy in the diagnosis of airway lesions.

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Author and article information

Contributors

Nobuhiko Seki: nseki@med.teikyo-u.ac.jp

Journal

Journal ID (nlm-ta): Infection

Journal ID (iso-abbrev): Infection

Title: Infection

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0300-8126

ISSN (Electronic): 1439-0973

Publication date (Electronic): 6 March 2022

Publication date PMC-release: 6 March 2022

Publication date (Print): 2022

Volume: 50

Issue: 3

Pages: 597-606

Affiliations

[1 ]GRID grid.26999.3d, ISNI 0000 0001 2151 536X, Department of Internal Medicine, , Teikyo University Graduate School of Medicine, ; Tokyo, Japan

[2 ]GRID grid.410843.a, ISNI 0000 0004 0466 8016, Department of Respiratory, , Kobe City Medical Center General Hospital, ; Kobe, Japan

[3 ]GRID grid.417089.3, ISNI 0000 0004 0378 2239, Department of Respiratory, , Tokyo Metropolitan Tama Medical Center, ; Tokyo, Japan

[4 ]GRID grid.416211.1, Department of Respiratory, , Niigata Prefectural Shibata Hospital, ; Niigata, Japan

[5 ]GRID grid.415106.7, ISNI 0000 0004 0641 4861, Department of Emergency Medicine, , Kawasaki Medical School Hospital, ; Okayama, Japan

[6 ]GRID grid.268441.d, ISNI 0000 0001 1033 6139, Department of Pulmonology, , Yokohama City University, ; Yokohama, Japan

[7 ]GRID grid.419151.9, ISNI 0000 0001 1545 6914, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, ; Tokyo, Japan

[8 ]GRID grid.412305.1, ISNI 0000 0004 1769 1397, Department of Oncology, , Teikyo University Hospital, ; 2-11-1 Kaga, Itahashi, Tokyo 173-8606 Japan

Article

Publisher ID: 1789

DOI: 10.1007/s15010-022-01789-9

PMC ID: 9151521

PubMed ID: 35249210

SO-VID: 1f1dc83a-9a22-4df1-a6ab-10980cbc4ca7

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 2 January 2022

Date accepted : 22 February 2022

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: interferon-gamma release assay,tuberculosis,people living with hiv,sensitivity,specificity

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: interferon-gamma release assay, tuberculosis, people living with hiv, sensitivity, specificity

Diagnostic accuracy of the interferon-gamma release assay in acquired immunodeficiency syndrome patients with suspected tuberculosis infection: a meta-analysis

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Abstract

Purpose

Methods

Results

Conclusion

Supplementary Information

Related collections

Point-Of-Care Testing for Tuberculosis

Most cited references 64

Measuring inconsistency in meta-analyses.

QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.

Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests.

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