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Meta-Analysis
. 2018 Oct;24(10):1055-1063.
doi: 10.1016/j.cmi.2017.11.018. Epub 2017 Dec 5.

Multiplex PCR system for the rapid diagnosis of respiratory virus infection: systematic review and meta-analysis

H-S Huang  1 , C-L Tsai  2 , J Chang  3 , T-C Hsu  4 , S Lin  5 , C-C Lee  6
Affiliations
Meta-Analysis

Multiplex PCR system for the rapid diagnosis of respiratory virus infection: systematic review and meta-analysis

H-S Huang et al. Clin Microbiol Infect. 2018 Oct.

Abstract

Objectives: To provide a summary of evidence for the diagnostic accuracies of three multiplex PCR systems (mPCRs)-BioFire FilmArray RP (FilmArray), Nanosphere Verigene RV+ test (Verigene RV+) and Hologic Gen-Probe Prodesse assays-on the detection of viral respiratory infections.

Methods: A comprehensive search up to 1 July 2017 was conducted on Medline and Embase for studies that utilized FilmArray, Verigene RV+ and Prodesse for diagnosis of viral respiratory infections. A summary of diagnostic accuracies for the following five viruses were calculated: influenza A virus (FluA), influenza B virus, respiratory syncytial virus, human metapneumovirus and adenovirus. Hierarchical summary receiver operating curves were used for estimating the viral detection performance per assay.

Results: Twenty studies of 5510 patient samples were eligible for analysis. Multiplex PCRs demonstrated high diagnostic accuracy, with area under the receiver operating characteristic curve (AUROC) equal to or more than 0.98 for all the above viruses except for adenovirus (AUROC 0.89). FilmArray, Verigene RV+ and ProFlu+ (the only Prodesse assay with enough data) demonstrated a summary sensitivity for FluA of 0.911 (95% confidence interval, 0.848-0.949), 0.949 (95% confidence interval, 0.882-0.979) and 0.954 (95% confidence interval, 0.871-0.985), respectively. The three mPCRs were comparable in terms of detection of FluA.

Conclusions: Point estimates calculated from eligible studies showed that the three mPCRs (FilmArray, Verigene RV+ and ProFlu+) are highly accurate and may provide important diagnostic information for early identification of respiratory virus infections. In patients with low pretest probability for FluA, these three mPCRs can predict a low possibility of infection and may justify withholding empirical antiviral treatments.

Keywords: Multiplex PCR; Point-of-care test; Respiratory virus infection.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram for selection of articles for meta-analysis.
Fig. 2
Fig. 2
QUADAS-2 for included studies. (a) QUADAS-2 bias assessment. (b) QUADAS-2 applicability assessment. QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies 2.
Fig. 3
Fig. 3
Forest plot of sensitivity and specificity of multiplex PCRs for diagnosis of each virus.
Fig. 4
Fig. 4
Receiver operating curve analysis of multiplex PCRs for detection of different virus infections. Solid lines indicate the 95% confidence region, and the dashed lines indicate the 95% prediction region. AUC, area under the curve.
See this image and copyright information in PMC

Comment in

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Further reading

    1. Sutton B.C., Maggert K., Rowell B., Etter R. Comparison of the focus diagnostics simplexa Flu A/B & RSV direct assay with the prodesse ProFlu+ assay for detection of influenza A virus (IAV), influenza B virus (IBV), and respiratory syncytial virus (RSV) in clinical specimens. J Mol Diagn. 2014;16:727–728.
    1. Espy M., Schneider S.K., Sloan L.M., Pritt B.S. Detection of influenza A, B and RSV in respiratory specimens by the proFlu+TM Kit and roche LC 480. J Mol Diagn. 2010;12:875.
    1. Irwin C., Matthews-Greer J., McRae K. Performance analysis of pandemic influenza detection methods. Am J Clin Pathol. 2012;138
    1. Buchan B., Anderson N., Jannetto P., Ledeboer N. Simultaneous detection of influenza A and its subtypes (H1, H3, 2009 H1N1), influenza B, and RSV A and B in respiratory specimens on an automated, random access, molecular platform. Clin Microbiol Infect. 2011;17:S3–S4.
    1. Alby K., Popowitch E.B., Miller M.B. Comparative evaluation of the Nanosphere Verigene RV+ assay and the Simplexa Flu A/B & RSV kit for detection of influenza and respiratory syncytial viruses. J Clin Microbiol. 2013;51:352–353. - PMC - PubMed

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