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Meta-Analysis
. 2018 Jun 25;18(1):284.
doi: 10.1186/s12879-018-3196-4.

Is Xpert MTB/RIF appropriate for diagnosing tuberculous pleurisy with pleural fluid samples? A systematic review

Zhen-Yu Huo  1 , Li Peng  2
Affiliations
Meta-Analysis

Is Xpert MTB/RIF appropriate for diagnosing tuberculous pleurisy with pleural fluid samples? A systematic review

Zhen-Yu Huo et al. BMC Infect Dis. .

Abstract

Background: Tuberculous pleurisy (TP) presents a diagnostic problem due to the limitations of traditional diagnostic methods. Different studies with the Xpert MTB/RIF assay have drawn variable conclusions about its values in TP diagnosis. We conducted a meta-analysis to assess whether the Xpert MTB/RIF assay is appropriate for the diagnosis of TP using pleural fluid samples.

Methods: A systematic search of four literature databases in English and Chinese language was performed to identify studies involving the use of Xpert MTB/RIF in patients with TP confirmed by plural biopsy and/or mycobacterial culture. Pooled sensitivity, specificity and accordance proportion were calculated, and the forest plots were generated to assess the accuracy of Xpert MTB/RIF for TP diagnosis.

Results: We identified 23 studies meeting our inclusion criteria. The pooled sensitivity and specificity of Xpert MTB/RIF were 30% (95% CI: 21-42%, I2 = 87.93%) and 99% (95% CI: 97-100%, I2 = 96.20%), respectively, and the area under the SROC curve (AUC) of Xpert MTB/RIF was 0.86 (95% CI: 0.83-0.89). Compared with drug susceptibility testing (DST), the pooled accordance rate of Xpert MTB/RIF in detecting rifampicin-susceptible cases and rifampicin-resistant cases was 99% (95% CI: 95-104%, I2 = 8.7%) and 94% (95% CI: 86-102%), respectively.

Conclusions: Our analysis suggests that the Xpert MTB/RIF assay is of limited value as a screening test for TP but has a high potential for confirming TP diagnosis and differentiating TP from non-TB diseases using pleural fluid samples.

Keywords: Pleural fluid; Rifampicin resistance; Systematic review; Tuberculous pleurisy; Xpert MTB/RIF.

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Conflict of interest statement

Ethics approval and consent to participate

All analyses were based on previous published studies, thus no ethical approval and patient consent are required.

Consent for publication

Not applicable.

Competing interests

All authors declare no competing interests. No competing interests exists in this study due to commercial or other associations (e.g., pharmaceutical stock ownership, consultancy, advisory board membership, relevant patents, or research funding). No competing interests exists in the submission of this manuscript, and the manuscript is approved by all of the authors for publication, all authors that the work described was original research that has not been published previously and is not under consideration for publication elsewhere in whole or in part.

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Figures

Fig. 1
Fig. 1
Flowchart diagram of the literature search process
Fig. 2
Fig. 2
Forest plots of the performance of Xpert MTB/RIF in diagnosing TP. See references [–, –36] for details
Fig. 3
Fig. 3
Symmetric receiver operator characteristic (SROC) curve for Xpert MTB/RIF assay. The SROC curve was derived by Stata/MP 13.1
Fig. 4
Fig. 4
Forest plots of the pooled accordance rate of the Xpert MTB/RIF and DST test results for rifampicin-susceptible cases (a) and rifampicin-resistant cases (b). See references [9, 31] for details
Fig. 5
Fig. 5
A Deeks’ funnel plot asymmetry test for evaluation of potential publication bias in Xpert MTB/RIF studies. This plot indicated a low risk of publication bias
See this image and copyright information in PMC

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