Diagnostic accuracy of the Xpert® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis
SETTING: Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE To investigate the associati...
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| Veröffentlicht in: | The international journal of tuberculosis and lung disease 2017-05, Vol.21 (5), p.493-502 |
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| creator | Lange, B. Khan, P. Kalmambetova, G. Al-Darraji, H. A. Alland, D. Antonenka, U. Brown, T. Balcells, M. E. Blakemore, R. Denkinger, C. M. Dheda, K. Hoffmann, H. Kadyrov, A. Lemaitre, N. Miller, M. B. Nikolayevskyy, V. Ntinginya, E. N. Ozkutuk, N. Palacios, J. J. Popowitch, E. B. Porcel, J. M. Teo, J. Theron, G. Kranzer, K. |
| description | SETTING: Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE
To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis.DESIGN: Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors
of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated.RESULTS: Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant
for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87).
Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples.CONCLUSION: Xpert CT values and smear status were strongly
associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen. |
| doi_str_mv | 10.5588/ijtld.16.0702 |
| format | Article |
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To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis.DESIGN: Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors
of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated.RESULTS: Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant
for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87).
Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples.CONCLUSION: Xpert CT values and smear status were strongly
associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen.</description><identifier>ISSN: 1027-3719</identifier><identifier>EISSN: 1815-7920</identifier><identifier>DOI: 10.5588/ijtld.16.0702</identifier><identifier>PMID: 28399963</identifier><language>eng</language><publisher>France: International Union Against Tuberculosis and Lung Disease</publisher><subject>Computed tomography ; Cycle Threshold Value ; Data analysis ; Data processing ; Diagnosis ; Diagnostic systems ; Humans ; Meta-analysis ; Microscopy ; Microscopy - methods ; Patients ; Polymerase chain reaction ; Polymerase Chain Reaction - methods ; Sensitivity and Specificity ; Smear ; Sputum - microbiology ; Systematic Review ; Tomography ; Tuberculosis ; Tuberculosis - diagnosis ; X-rays ; Xpert</subject><ispartof>The international journal of tuberculosis and lung disease, 2017-05, Vol.21 (5), p.493-502</ispartof><rights>Copyright International Union against Tuberculosis and Lung Disease (IUATLD) May 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c560t-b1be26d11319a61e9e5e1905d9a720aa057a66aa70ccef27f28118c6e8dbc0413</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28399963$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lange, B.</creatorcontrib><creatorcontrib>Khan, P.</creatorcontrib><creatorcontrib>Kalmambetova, G.</creatorcontrib><creatorcontrib>Al-Darraji, H. A.</creatorcontrib><creatorcontrib>Alland, D.</creatorcontrib><creatorcontrib>Antonenka, U.</creatorcontrib><creatorcontrib>Brown, T.</creatorcontrib><creatorcontrib>Balcells, M. E.</creatorcontrib><creatorcontrib>Blakemore, R.</creatorcontrib><creatorcontrib>Denkinger, C. M.</creatorcontrib><creatorcontrib>Dheda, K.</creatorcontrib><creatorcontrib>Hoffmann, H.</creatorcontrib><creatorcontrib>Kadyrov, A.</creatorcontrib><creatorcontrib>Lemaitre, N.</creatorcontrib><creatorcontrib>Miller, M. B.</creatorcontrib><creatorcontrib>Nikolayevskyy, V.</creatorcontrib><creatorcontrib>Ntinginya, E. N.</creatorcontrib><creatorcontrib>Ozkutuk, N.</creatorcontrib><creatorcontrib>Palacios, J. J.</creatorcontrib><creatorcontrib>Popowitch, E. B.</creatorcontrib><creatorcontrib>Porcel, J. M.</creatorcontrib><creatorcontrib>Teo, J.</creatorcontrib><creatorcontrib>Theron, G.</creatorcontrib><creatorcontrib>Kranzer, K.</creatorcontrib><title>Diagnostic accuracy of the Xpert® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis</title><title>The international journal of tuberculosis and lung disease</title><addtitle>Int J Tuberc Lung Dis</addtitle><description>SETTING: Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE
To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis.DESIGN: Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors
of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated.RESULTS: Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant
for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87).
Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples.CONCLUSION: Xpert CT values and smear status were strongly
associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen.</description><subject>Computed tomography</subject><subject>Cycle Threshold Value</subject><subject>Data analysis</subject><subject>Data processing</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Humans</subject><subject>Meta-analysis</subject><subject>Microscopy</subject><subject>Microscopy - methods</subject><subject>Patients</subject><subject>Polymerase chain reaction</subject><subject>Polymerase Chain Reaction - methods</subject><subject>Sensitivity and Specificity</subject><subject>Smear</subject><subject>Sputum - microbiology</subject><subject>Systematic Review</subject><subject>Tomography</subject><subject>Tuberculosis</subject><subject>Tuberculosis - diagnosis</subject><subject>X-rays</subject><subject>Xpert</subject><issn>1027-3719</issn><issn>1815-7920</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1ks9u1DAQhyMEoqVw5IosceGSrcepY4cbtBQqFYFQkbhZs85k61X-LLazUnioPkSfDGd3CxISvngkf_o8mt9k2UvgCym1PnXr2NYLKBdccfEoOwYNMleV4I9TzYXKCwXVUfYshDXnAgDU0-xI6KKqqrI4zroLh6t-CNFZhtaOHu3EhobFW2I_NuTj_R37fPP-9NvVJbOTbSm9eAq3Q1uzlrbUsjiwjafa2chCR-jZZgguuq2L01uGrKOIOfbYTsGF59mTBttALw73Sfb98sPN-af8-svHq_N317mVJY_5EpYkyhqggApLoIokQcVlXaESHJFLhWWJqLi11AjVCA2gbUm6Xlp-BsVJ9mbv3fjh50ghms4FS22LPQ1jMKC14pKXhUjo63_Q9TD61G8wgsOZTIzSicr3lPVDCJ4as_GuQz8Z4GbOwexyMFCaOYfEvzpYx2VH9R_6YfAJuNgDrl9RH_Hvr27E2bT3pRaU4bsj4FBwadDHXZE0X_-nsQ-meQvmJTBbAb1MSgFcC2lAJlNNDY5tNBG9Wf0yQRa_AZL9tZY</recordid><startdate>20170501</startdate><enddate>20170501</enddate><creator>Lange, B.</creator><creator>Khan, P.</creator><creator>Kalmambetova, G.</creator><creator>Al-Darraji, H. A.</creator><creator>Alland, D.</creator><creator>Antonenka, U.</creator><creator>Brown, T.</creator><creator>Balcells, M. E.</creator><creator>Blakemore, R.</creator><creator>Denkinger, C. M.</creator><creator>Dheda, K.</creator><creator>Hoffmann, H.</creator><creator>Kadyrov, A.</creator><creator>Lemaitre, N.</creator><creator>Miller, M. B.</creator><creator>Nikolayevskyy, V.</creator><creator>Ntinginya, E. N.</creator><creator>Ozkutuk, N.</creator><creator>Palacios, J. J.</creator><creator>Popowitch, E. B.</creator><creator>Porcel, J. M.</creator><creator>Teo, J.</creator><creator>Theron, G.</creator><creator>Kranzer, K.</creator><general>International Union Against Tuberculosis and Lung Disease</general><general>International Union against Tuberculosis and Lung Disease (IUATLD)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>20170501</creationdate><title>Diagnostic accuracy of the Xpert® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis</title><author>Lange, B. ; Khan, P. ; Kalmambetova, G. ; Al-Darraji, H. A. ; Alland, D. ; Antonenka, U. ; Brown, T. ; Balcells, M. E. ; Blakemore, R. ; Denkinger, C. M. ; Dheda, K. ; Hoffmann, H. ; Kadyrov, A. ; Lemaitre, N. ; Miller, M. B. ; Nikolayevskyy, V. ; Ntinginya, E. N. ; Ozkutuk, N. ; Palacios, J. J. ; Popowitch, E. B. ; Porcel, J. M. ; Teo, J. ; Theron, G. ; Kranzer, K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c560t-b1be26d11319a61e9e5e1905d9a720aa057a66aa70ccef27f28118c6e8dbc0413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Computed tomography</topic><topic>Cycle Threshold Value</topic><topic>Data analysis</topic><topic>Data processing</topic><topic>Diagnosis</topic><topic>Diagnostic systems</topic><topic>Humans</topic><topic>Meta-analysis</topic><topic>Microscopy</topic><topic>Microscopy - methods</topic><topic>Patients</topic><topic>Polymerase chain reaction</topic><topic>Polymerase Chain Reaction - methods</topic><topic>Sensitivity and Specificity</topic><topic>Smear</topic><topic>Sputum - microbiology</topic><topic>Systematic Review</topic><topic>Tomography</topic><topic>Tuberculosis</topic><topic>Tuberculosis - diagnosis</topic><topic>X-rays</topic><topic>Xpert</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lange, B.</creatorcontrib><creatorcontrib>Khan, P.</creatorcontrib><creatorcontrib>Kalmambetova, G.</creatorcontrib><creatorcontrib>Al-Darraji, H. A.</creatorcontrib><creatorcontrib>Alland, D.</creatorcontrib><creatorcontrib>Antonenka, U.</creatorcontrib><creatorcontrib>Brown, T.</creatorcontrib><creatorcontrib>Balcells, M. E.</creatorcontrib><creatorcontrib>Blakemore, R.</creatorcontrib><creatorcontrib>Denkinger, C. M.</creatorcontrib><creatorcontrib>Dheda, K.</creatorcontrib><creatorcontrib>Hoffmann, H.</creatorcontrib><creatorcontrib>Kadyrov, A.</creatorcontrib><creatorcontrib>Lemaitre, N.</creatorcontrib><creatorcontrib>Miller, M. B.</creatorcontrib><creatorcontrib>Nikolayevskyy, V.</creatorcontrib><creatorcontrib>Ntinginya, E. N.</creatorcontrib><creatorcontrib>Ozkutuk, N.</creatorcontrib><creatorcontrib>Palacios, J. J.</creatorcontrib><creatorcontrib>Popowitch, E. B.</creatorcontrib><creatorcontrib>Porcel, J. M.</creatorcontrib><creatorcontrib>Teo, J.</creatorcontrib><creatorcontrib>Theron, G.</creatorcontrib><creatorcontrib>Kranzer, K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The international journal of tuberculosis and lung disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lange, B.</au><au>Khan, P.</au><au>Kalmambetova, G.</au><au>Al-Darraji, H. A.</au><au>Alland, D.</au><au>Antonenka, U.</au><au>Brown, T.</au><au>Balcells, M. E.</au><au>Blakemore, R.</au><au>Denkinger, C. M.</au><au>Dheda, K.</au><au>Hoffmann, H.</au><au>Kadyrov, A.</au><au>Lemaitre, N.</au><au>Miller, M. B.</au><au>Nikolayevskyy, V.</au><au>Ntinginya, E. N.</au><au>Ozkutuk, N.</au><au>Palacios, J. J.</au><au>Popowitch, E. B.</au><au>Porcel, J. M.</au><au>Teo, J.</au><au>Theron, G.</au><au>Kranzer, K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic accuracy of the Xpert® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis</atitle><jtitle>The international journal of tuberculosis and lung disease</jtitle><addtitle>Int J Tuberc Lung Dis</addtitle><date>2017-05-01</date><risdate>2017</risdate><volume>21</volume><issue>5</issue><spage>493</spage><epage>502</epage><pages>493-502</pages><issn>1027-3719</issn><eissn>1815-7920</eissn><abstract>SETTING: Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE
To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis.DESIGN: Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors
of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated.RESULTS: Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant
for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87).
Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples.CONCLUSION: Xpert CT values and smear status were strongly
associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen.</abstract><cop>France</cop><pub>International Union Against Tuberculosis and Lung Disease</pub><pmid>28399963</pmid><doi>10.5588/ijtld.16.0702</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The international journal of tuberculosis and lung disease, 2017-05, Vol.21 (5), p.493-502 |
| issn | 1027-3719 1815-7920 |
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| source | MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Computed tomography Cycle Threshold Value Data analysis Data processing Diagnosis Diagnostic systems Humans Meta-analysis Microscopy Microscopy - methods Patients Polymerase chain reaction Polymerase Chain Reaction - methods Sensitivity and Specificity Smear Sputum - microbiology Systematic Review Tomography Tuberculosis Tuberculosis - diagnosis X-rays Xpert |
| title | Diagnostic accuracy of the Xpert® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis |
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