Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.

<h4>Background</h4>Serological (antibody detection) tests for tuberculosis (TB) are widely used in developing countries. As part of a World Health Organization policy process, we performed an updated systematic review to assess the diagnostic accuracy of commercial serological tests for...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Karen R Steingart, Laura L Flores, Nandini Dendukuri, Ian Schiller, Suman Laal, Andrew Ramsay, Philip C Hopewell, Madhukar Pai
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/5103da4d168345e0b49106a00a269d2a
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:5103da4d168345e0b49106a00a269d2a
record_format	dspace
spelling	oai:doaj.org-article:5103da4d168345e0b49106a00a269d2a2021-12-02T19:55:49ZCommercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.1549-12771549-167610.1371/journal.pmed.1001062https://doaj.org/article/5103da4d168345e0b49106a00a269d2a2011-08-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21857806/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Serological (antibody detection) tests for tuberculosis (TB) are widely used in developing countries. As part of a World Health Organization policy process, we performed an updated systematic review to assess the diagnostic accuracy of commercial serological tests for pulmonary and extrapulmonary TB with a focus on the relevance of these tests in low- and middle-income countries.<h4>Methods and findings</h4>We used methods recommended by the Cochrane Collaboration and GRADE approach for rating quality of evidence. In a previous review, we searched multiple databases for papers published from 1 January 1990 to 30 May 2006, and in this update, we add additional papers published from that period until 29 June 2010. We prespecified subgroups to address heterogeneity and summarized test performance using bivariate random effects meta-analysis. For pulmonary TB, we included 67 studies (48% from low- and middle-income countries) with 5,147 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (31% to 100%). For anda-TB IgG, the only test with enough studies for meta-analysis, pooled sensitivity was 76% (95% CI 63%-87%) in smear-positive (seven studies) and 59% (95% CI 10%-96%) in smear-negative (four studies) patients; pooled specificities were 92% (95% CI 74%-98%) and 91% (95% CI 79%-96%), respectively. Compared with ELISA (pooled sensitivity 60% [95% CI 6%-65%]; pooled specificity 98% [95% CI 96%-99%]), immunochromatographic tests yielded lower pooled sensitivity (53%, 95% CI 42%-64%) and comparable pooled specificity (98%, 95% CI 94%-99%). For extrapulmonary TB, we included 25 studies (40% from low- and middle-income countries) with 1,809 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (59% to 100%). Overall, quality of evidence was graded very low for studies of pulmonary and extrapulmonary TB.<h4>Conclusions</h4>Despite expansion of the literature since 2006, commercial serological tests continue to produce inconsistent and imprecise estimates of sensitivity and specificity. Quality of evidence remains very low. These data informed a recently published World Health Organization policy statement against serological tests. Please see later in the article for the Editors' Summary.Karen R SteingartLaura L FloresNandini DendukuriIan SchillerSuman LaalAndrew RamsayPhilip C HopewellMadhukar PaiPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 8, Iss 8, p e1001062 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Karen R Steingart Laura L Flores Nandini Dendukuri Ian Schiller Suman Laal Andrew Ramsay Philip C Hopewell Madhukar Pai Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.
description	<h4>Background</h4>Serological (antibody detection) tests for tuberculosis (TB) are widely used in developing countries. As part of a World Health Organization policy process, we performed an updated systematic review to assess the diagnostic accuracy of commercial serological tests for pulmonary and extrapulmonary TB with a focus on the relevance of these tests in low- and middle-income countries.<h4>Methods and findings</h4>We used methods recommended by the Cochrane Collaboration and GRADE approach for rating quality of evidence. In a previous review, we searched multiple databases for papers published from 1 January 1990 to 30 May 2006, and in this update, we add additional papers published from that period until 29 June 2010. We prespecified subgroups to address heterogeneity and summarized test performance using bivariate random effects meta-analysis. For pulmonary TB, we included 67 studies (48% from low- and middle-income countries) with 5,147 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (31% to 100%). For anda-TB IgG, the only test with enough studies for meta-analysis, pooled sensitivity was 76% (95% CI 63%-87%) in smear-positive (seven studies) and 59% (95% CI 10%-96%) in smear-negative (four studies) patients; pooled specificities were 92% (95% CI 74%-98%) and 91% (95% CI 79%-96%), respectively. Compared with ELISA (pooled sensitivity 60% [95% CI 6%-65%]; pooled specificity 98% [95% CI 96%-99%]), immunochromatographic tests yielded lower pooled sensitivity (53%, 95% CI 42%-64%) and comparable pooled specificity (98%, 95% CI 94%-99%). For extrapulmonary TB, we included 25 studies (40% from low- and middle-income countries) with 1,809 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (59% to 100%). Overall, quality of evidence was graded very low for studies of pulmonary and extrapulmonary TB.<h4>Conclusions</h4>Despite expansion of the literature since 2006, commercial serological tests continue to produce inconsistent and imprecise estimates of sensitivity and specificity. Quality of evidence remains very low. These data informed a recently published World Health Organization policy statement against serological tests. Please see later in the article for the Editors' Summary.
format	article
author	Karen R Steingart Laura L Flores Nandini Dendukuri Ian Schiller Suman Laal Andrew Ramsay Philip C Hopewell Madhukar Pai
author_facet	Karen R Steingart Laura L Flores Nandini Dendukuri Ian Schiller Suman Laal Andrew Ramsay Philip C Hopewell Madhukar Pai
author_sort	Karen R Steingart
title	Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.
title_short	Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.
title_full	Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.
title_fullStr	Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.
title_full_unstemmed	Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.
title_sort	commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/5103da4d168345e0b49106a00a269d2a
work_keys_str_mv	AT karenrsteingart commercialserologicaltestsforthediagnosisofactivepulmonaryandextrapulmonarytuberculosisanupdatedsystematicreviewandmetaanalysis AT lauralflores commercialserologicaltestsforthediagnosisofactivepulmonaryandextrapulmonarytuberculosisanupdatedsystematicreviewandmetaanalysis AT nandinidendukuri commercialserologicaltestsforthediagnosisofactivepulmonaryandextrapulmonarytuberculosisanupdatedsystematicreviewandmetaanalysis AT ianschiller commercialserologicaltestsforthediagnosisofactivepulmonaryandextrapulmonarytuberculosisanupdatedsystematicreviewandmetaanalysis AT sumanlaal commercialserologicaltestsforthediagnosisofactivepulmonaryandextrapulmonarytuberculosisanupdatedsystematicreviewandmetaanalysis AT andrewramsay commercialserologicaltestsforthediagnosisofactivepulmonaryandextrapulmonarytuberculosisanupdatedsystematicreviewandmetaanalysis AT philipchopewell commercialserologicaltestsforthediagnosisofactivepulmonaryandextrapulmonarytuberculosisanupdatedsystematicreviewandmetaanalysis AT madhukarpai commercialserologicaltestsforthediagnosisofactivepulmonaryandextrapulmonarytuberculosisanupdatedsystematicreviewandmetaanalysis
_version_	1718375838070603776

Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.

Ejemplares similares