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Meta-Analysis
. 2020 Dec 1;15(12):e0243161.
doi: 10.1371/journal.pone.0243161. eCollection 2020.

Metagenomic next generation sequencing for the diagnosis of tuberculosis meningitis: A systematic review and meta-analysis

Guocan Yu  1 , Wuchen Zhao  1 , Yanqin Shen  1 , Pengfei Zhu  1 , Hong Zheng  1
Affiliations
Meta-Analysis

Metagenomic next generation sequencing for the diagnosis of tuberculosis meningitis: A systematic review and meta-analysis

Guocan Yu et al. PLoS One. .

Abstract

Background: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis and its early diagnosis is very difficult leading to present with severe disability or die. The current study aimed to assess the accuracy of metagenomic next generation sequencing (mNGS) for TBM, and to identify a new test for the early diagnosis of TBM.

Methods: We searched for articles published in Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data up to June 30, 2020 for studies that assessed the efficacy of mNGS for the diagnosis of TBM. Then, the accuracy between mNGS and a composite reference standard (CRS) in these articles was compared using the meta-analysis approach.

Results: Four independent studies with 342 samples comparing mNGS and a CRS were included in this study. The sensitivity of mNGS for TBM diagnosis ranged from 27% to 84%. The combined sensitivity of mNGS was 61%, and the I2 value was 92%. Moreover, the specificity of mNGS for TBM diagnosis ranged from 96% to 100%. The combined specificity of mNGS was 98%, and the I2 value was 74%. The heterogeneity between studies in terms of sensitivity and specificity was significant. The area under the curve (AUC) of the summary receiver operating characteristic curve (SROC) of mNGS for TBM was 0.98.

Conclusions: The sensitivity of mNGS for TBM diagnosis was moderate. Furthermore, the specificity was extremely high, and the AUC of the SROC indicated a very good diagnostic efficacy. mNGS could be used as an early diagnostic method for TBM, however, the results should be treated with caution for the heterogeneity between studies was extremely significant.

Systematic review registration: INPLASY202070100.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of literature retrieval.
In total, 507, 53, 0, 242, and 295 articles were found in Embase, PubMed, Cochrane Library, CNKI, and Wanfang Data, respectively.
Fig 2
Fig 2. Methodological quality graphs (risk of bias and applicability concerns) were presented as percentages across the included studies using a composite reference standard.
Fig 3
Fig 3. Forest plot for the sensitivity and specificity of mNGS for the diagnosis of tuberculosis meningitis using a composite reference standard.
See this image and copyright information in PMC

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