Key result
Xpert MTB/RIF demonstrated a robust pooled specificity of 0.994 but an unsatisfactory pooled sensitivity of 0.676 in diagnosing tuberculous pericarditis.
Why the study?
Studies have reported varied accuracy of Xpert MTB/RIF in detecting Mycobacterium tuberculosis in pericardial effusion.
Does Xpert MTB/RIF accurately diagnose tuberculous pericarditis in patients with pericardial effusion compared to culture?
Meta-Analysis (n=581)
Does Xpert MTB/RIF accurately diagnose tuberculous pericarditis in patients with pericardial effusion compared to culture?
Xpert MTB/RIF has robust specificity but unsatisfactory sensitivity for diagnosing tuberculous pericarditis, meaning positive results are valuable for ruling in the diagnosis, but negative results cannot rule it out.
Positive Xpert MTB/RIF supports ruling in tuberculous pericarditis; leaves open need for more sensitive tests to exclude disease.
<ns3:p> <ns3:bold>Introduction</ns3:bold> : Xpert MTB/RIF is a rapid diagnostic instrument for pulmonary tuberculosis (TB). However, studies reported varied accuracy of Xpert MTB/RIF in detecting <ns3:italic>Mycobacterium tuberculosis</ns3:italic> in pericardial effusion. </ns3:p> <ns3:p> <ns3:bold>Methods</ns3:bold> : We performed a systematic review of literature in PubMed, published up to February 1, 2020, according to PRISMA guidelines. We screened cross-sectional studies, observational cohort studies, and randomized control trials that evaluated the accuracy of Xpert MTB/RIF in diagnosing TB pericarditis. Papers with noninterpretable results of sensitivity and specificity, non-English articles, and unpublished studies were excluded. The primary outcomes were the sensitivity and specificity of Xpert MTB/RIF. We conducted a quality assessment using QUADAS-2 to evaluate the quality of the studies. A bivariate model pooled the overall sensitivity, specificity, positive likelihood ratios (PLRs), and negative likelihood ratios (NLRs) of included studies. </ns3:p> <ns3:p> <ns3:bold>Results</ns3:bold> : In total, 581 subjects from nine studies were analyzed in this meta-analysis. Our pooled analysis showed that the overall sensitivity, specificity, PLRs and NLRs of included studies were 0.676 (95% CI: 0.580–0.759), 0.994 (95% CI: 0.919–1.000), 110.11 (95% CI: 7.65–1584.57) and 0.326 (95% CI: 0.246–0.433), respectively. </ns3:p> <ns3:p> <ns3:bold>Conclusions</ns3:bold> : Xpert MTB/RIF had a robust specificity but unsatisfactory sensitivity in diagnosing TB pericarditis. These findings indicated that although positive Xpert MTB/RIF test results might be valuable in swiftly distinguishing the diagnosis of TB pericarditis, negative test results might not be able to rule out TB pericarditis. </ns3:p> <ns3:p> <ns3:bold>Registration</ns3:bold> : PROSPERO <ns3:ext-link xmlns:ns4="http://www.w3.org/1999/xlink" ext-link-type="uri" ns4:href="https://www.crd.york.ac.uk/prospero/display_record.php?
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Andrianto et al. (2020) conducted a meta-analysis in Tuberculous pericarditis (n=581). Xpert MTB/RIF vs. Culture (reference standard) was evaluated on Sensitivity and specificity of Xpert MTB/RIF (Sensitivity 0.676, Specificity 0.994, 95% CI Sensitivity 0.580-0.759, Specificity 0.919-1.000). Xpert MTB/RIF demonstrated a robust pooled specificity of 0.994 but an unsatisfactory pooled sensitivity of 0.676 in diagnosing tuberculous pericarditis.
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