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

Diagnostic accuracy of Xpert MTB/RIF for tuberculosis detection in different regions with different endemic burden: A systematic review and meta-analysis.
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Li S, Liu B, Peng M, Chen M, Yin W, Tang H, Luo Y, Hu P, Ren H,


Li S, Liu B, Peng M, Chen M, Yin W, Tang H, Luo Y, Hu P, Ren H, (click to view)

Li S, Liu B, Peng M, Chen M, Yin W, Tang H, Luo Y, Hu P, Ren H,

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PloS one 2017 07 1412(7) e0180725 doi 10.1371/journal.pone.0180725

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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