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Meta-Analysis
. 2017 Jul 14;12(7):e0180725.
doi: 10.1371/journal.pone.0180725. eCollection 2017.

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

Shiying Li  1 , Bin Liu  1 , Mingli Peng  1 , Min Chen  1 , Wenwei Yin  1 , Hui Tang  1 , Yuxuan Luo  1 , Peng Hu  1 , Hong Ren  1
Affiliations
Meta-Analysis

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

Shiying Li et al. PLoS One. .

Abstract

Purpose: To estimate the diagnostic accuracy of Xpert MTB/RIF, a systematic review and meta-analysis were carried out.

Methods: Up to June 20, 2015, multiple databases were screened for relevant studies.

Results: 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).

Conclusions: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
The overall methodological quality of all included studies for tuberculosis detection versus (A) culture reference standard, and (B) CRS.
Fig 2
Fig 2
The SROC plot of Xpert MTB/RIF’s sensitivity, specificity and AUC (area under the curve) for tuberculosis detection versus (A) culture and (B) CRS. The sensitivity and specificity of one study were represented as a point; the summary sensitivity and specificity was represented as a summary point.
Fig 3
Fig 3. The SROC plot of Xpert MTB/RIF’s sensitivity, specificity and AUC (area under the curve) for tuberculosis detection in different prevalence regions versus culture reference standard.
(A) High TB burden regions, (B) Middle and low prevalence regions. The sensitivity and specificity of one study were represented as a point; the summary sensitivity and specificity was represented as a summary point.
See this image and copyright information in PMC

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