Renu Gupta1, Puneet Talwar2, Pumanshi Talwar3, Sarbjeet Khurana4, Suman Kushwaha5, Nupur Jalan6, Rajeev Thakur6. 1. Department of Microbiology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India. Electronic address: renugoyal_123@yahoo.co.in. 2. Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India. Electronic address: talwar.puneet@gmail.com. 3. Department of Microbiology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India; Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India. 4. Department of Epidemiology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India. 5. Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India. 6. Department of Microbiology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India.
Abstract
BACKGROUND: Numerous in-house and commercial nucleic acid amplification tests (NAAT) have been evaluated using variable reference standards for diagnosis of TBM but their diagnostic potential is still not very clear. METHODS: We conducted a meta-analysis to assess the diagnostic accuracy of different NAAT based assays for diagnosing TBM against 43 data sets of confirmed TBM (n = 1066) and 61 data sets of suspected TBM (n = 3721) as two reference standards. The summary estimate of the sensitivity and the specificity were obtained using the bivariate model. QUADAS-2 tool was used to perform the Quality assessment for bias and applicability. Publication bias was assessed with Deeks' funnel plot. RESULTS: Studies with confirmed TBM had better summary estimates as compared to studies with clinically suspected TBM irrespective of NAAT and index tests used. Among in-house assays, MPB as the gene target had best summary estimates in both confirmed [sensitivity:90%(83-95), specificity:97-%(87-99), DOR:247 (50-1221), AUC:99%(97-100), PLR:38.8-(6.6-133), NLR:0.11(0.05-0.18), I2 = 15%] and clinically suspected [sensitivity:69%(47-85), specificity:96%(90-98), DOR:62(16.8-232), AUC:94%(92-97), PLR:16.9(6.5-36.8), NLR:0.33(0.16-0.56), I2:15.3%] groups. GeneXpert revealed good diagnostic accuracy only in confirmed TBM group [sensitivity = 57%(38-74), specificity = 98%(89-100), DOR = 62(7-589), AUC = 87%(79-96), PLR = 33.2(3.8-128), NLR = 0.45(0.26-0.68), I2 = 0%]. CONCLUSIONS: This meta-analysis identified potential role of MPB gene among in-house assays and GeneXpert as commercial assay for diagnosing TBM.
BACKGROUND: Numerous in-house and commercial nucleic acid amplification tests (NAAT) have been evaluated using variable reference standards for diagnosis of TBM but their diagnostic potential is still not very clear. METHODS: We conducted a meta-analysis to assess the diagnostic accuracy of different NAAT based assays for diagnosing TBM against 43 data sets of confirmed TBM (n = 1066) and 61 data sets of suspected TBM (n = 3721) as two reference standards. The summary estimate of the sensitivity and the specificity were obtained using the bivariate model. QUADAS-2 tool was used to perform the Quality assessment for bias and applicability. Publication bias was assessed with Deeks' funnel plot. RESULTS: Studies with confirmed TBM had better summary estimates as compared to studies with clinically suspected TBM irrespective of NAAT and index tests used. Among in-house assays, MPB as the gene target had best summary estimates in both confirmed [sensitivity:90%(83-95), specificity:97-%(87-99), DOR:247 (50-1221), AUC:99%(97-100), PLR:38.8-(6.6-133), NLR:0.11(0.05-0.18), I2 = 15%] and clinically suspected [sensitivity:69%(47-85), specificity:96%(90-98), DOR:62(16.8-232), AUC:94%(92-97), PLR:16.9(6.5-36.8), NLR:0.33(0.16-0.56), I2:15.3%] groups. GeneXpert revealed good diagnostic accuracy only in confirmed TBM group [sensitivity = 57%(38-74), specificity = 98%(89-100), DOR = 62(7-589), AUC = 87%(79-96), PLR = 33.2(3.8-128), NLR = 0.45(0.26-0.68), I2 = 0%]. CONCLUSIONS: This meta-analysis identified potential role of MPB gene among in-house assays and GeneXpert as commercial assay for diagnosing TBM.