Diagnostic accuracy of Xpert MTB/RIF for tuberculosis detection in different regions with different endemic burden: A systematic review and meta-analysis

• Published in: PloS one Vol. 12; no. 7; p. e0180725
• Main Authors: Li, Shiying, Liu, Bin, Peng, Mingli, Chen, Min, Yin, Wenwei, Tang, Hui, Luo, Yuxuan, Hu, Peng, Ren, Hong
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.07.2017; Public Library of Science (PLoS)
• Subjects: Accuracy; Adults; Area Under Curve; Biology and Life Sciences; Confidence intervals; Databases, Factual; Diagnosis; Diagnostic equipment (Medical); Diagnostic systems; Diagnostic tests; DNA, Bacterial - isolation & purification; DNA, Bacterial - metabolism; Drug resistance; Education; Epidemiology; Hepatitis; HIV; HIV Infections - complications; Hospitals; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Laboratories; Lung diseases; Medical diagnosis; Medical personnel; Medical research; Medicine and Health Sciences; Meta-analysis; Molecular biology; Mycobacterium tuberculosis; Mycobacterium tuberculosis - genetics; Mycobacterium tuberculosis - isolation & purification; Patients; Physical Sciences; Physicians; Reference Standards; Research and Analysis Methods; ROC Curve; Sensitivity; Smear; Studies; Tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - microbiology; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0180725

To estimate the diagnostic accuracy of Xpert MTB/RIF, a systematic review and meta-analysis were carried out. Up to June 20, 2015, multiple databases were screened for relevant studies. Accordingly, 106 studies included 52,410 samples were selected. Diagnostic accuracy of Xpert MTB/RIF for TB detection was validated against either culture or a composite reference standard (CRS). Additionally, selected studies were further subgrouped in four groups based on sample's type, subject's age, status of HIV co-infection and smear-positivity. The overall pooled sensitivity and specificity of Xpert MTB/RIF was 0.85 (95% confidence interval [CI] 0.82-0.88) and 0.98 (95% CI 0.96-0.98), respectively, compared to culture; while it was 0.59 (95% CI 0.44-0.72) and 0.99 (95% CI 0.97-1.00) compared to CRS. The overall sensitivity was lower in countries with high TB prevalence than countries with middle/low prevalence (0.84, 95% CI: 0.80-0.88 versus 0.89, 95% CI: 0.84-0.93). Furthermore, Xpert MTB/RIF has higher sensitivity in patients with positive smears (0.99, 95% CI 0.97-0.99), in patients with pulmonary TB samples (0.87, 95% CI 0.83-0.90), in adults (0.82, 95% CI 0.76-0.86) and in HIV-positive patients (0.81, 95% CI 0.73-0.87). Taken together, Xpert MTB/RIF is a quick and accurate diagnostic assay for TB which will significantly help the physicians to make their clinical decisions.