BackgroundTuberculous pleurisy (TP) presents a diagnostic problem due to the limitations of traditional diagnostic methods. Different studies with the Xpert MTB/RIF assay have drawn variable conclusions about its values in TP diagnosis. We conducted a meta-analysis to assess whether the Xpert MTB/RIF assay is appropriate for the diagnosis of TP using pleural fluid samples.MethodsA systematic search of four literature databases in English and Chinese language was performed to identify studies involving the use of Xpert MTB/RIF in patients with TP confirmed by plural biopsy and/or mycobacterial culture. Pooled sensitivity, specificity and accordance proportion were calculated, and the forest plots were generated to assess the accuracy of Xpert MTB/RIF for TP diagnosis.ResultsWe identified 23 studies meeting our inclusion criteria. The pooled sensitivity and specificity of Xpert MTB/RIF were 30% (95% CI: 21–42%, I2 = 87.93%) and 99% (95% CI: 97–100%, I2 = 96.20%), respectively, and the area under the SROC curve (AUC) of Xpert MTB/RIF was 0.86 (95% CI: 0.83–0.89). Compared with drug susceptibility testing (DST), the pooled accordance rate of Xpert MTB/RIF in detecting rifampicin-susceptible cases and rifampicin-resistant cases was 99% (95% CI: 95–104%, I2 = 8.7%) and 94% (95% CI: 86–102%), respectively.ConclusionsOur analysis suggests that the Xpert MTB/RIF assay is of limited value as a screening test for TP but has a high potential for confirming TP diagnosis and differentiating TP from non-TB diseases using pleural fluid samples.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3196-4) contains supplementary material, which is available to authorized users.

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Background: Although the interferon-γ release assay (IGRA) has become a widely accepted means for the diagnosis of latent tuberculosis infection (LTBI), the role of the IGRA in diagnosing active tuberculosis (ATB) among human immunodeficiency virus (HIV)-seropositive individuals remains controversial. Previous analyses did not set up rational inclusive criteria for screening articles with strict control groups and a gold standard for ATB diagnosis. Therefore, we conducted a systematic review of the latest evidence to evaluate the accuracy of IGRA for HIV-seropositive patients.

BackgroundDespite increasing incidence of pulmonary fungal infections (PFIs) worldwide, the clinical characteristics and prognostic factors remain poorly understood. The goal of this study was to investigate the clinical features, laboratory findings, and outcomes of hospitalized patients diagnosed with PFIs.MethodsWe retrospectively enrolled 123 patients at a university hospital in Southwestern China between February 2014 and May 2016, who were diagnosed with PFIs based on clinical presentations and laboratory tests including fungal culture and pathological examination. Medical records were reviewed and analyzed. Prognostic factor associated with mortality was evaluated by multivariate regression analysis.ResultsOf the 123 PFI patients enrolled, the mean age was 67 years with 72% of them being males. In addition to common clinical features reported previously, these patients exhibited distinct characteristics, with the elderly accounting for 79% of all cases, and with prolonged hospitalization being the most prevalent risk factor (74%) and chronic obstructive pulmonary disease (COPD) being the most common underlying disease (45%). Invasive operation was significantly more frequently involved in patients with unfavorable treatment responses than in patients with favorable responses (45.6 vs 7.4%, P=0.000). By multivariate regression analysis, invasive operation (odds ratio [OR]: 5.736, 95% confidence interval [CI]: 2.008–16.389, P=0.001) and hypoalbuminemia (OR: 3.936, 95% CI: 1.325–11.696, P=0.014) were independent prognostic factors of mortality in PFIs.ConclusionThis study provides new insights into the clinical characteristics and prognostic factors of PFIs and highlights the necessity to be aware of PFIs in patients with COPD and patients receiving invasive operation in order to improve clinical management of these patients.

Background Malnutrition defined by the Global Leadership Initiative on Malnutrition (GLIM) has been associated with cancer mortality, but the effect is limited and inconsistent. We performed this meta‐analysis aiming to assess this relationship in patients with cancer. Methods We systematically searched Embase, PubMed, Web of Science, Cochrane, CINAHL, CNKI, Wanfang, and VIP databases from January 1, 2019, to July 1, 2022. Studies evaluating the prognostic effect of GLIM‐defined malnutrition on cancer survival were included. A fixed‐effect model was fitted to estimate the combined hazard ratio (HR) with a 95% CI. Heterogeneity of studies was analyzed using the I2 statistic. Quality assessment were performed using the Newcastle‐Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results The search strategy identified 4378 articles in all databases combined. Nine studies (8829 patients) meeting the inclusion criteria were included for quantitative analysis. Meta‐analysis revealed significant associations between GLIM‐defined pooled malnutrition (HR = 1.75; 95% CI, 1.43–2.15), moderate malnutrition (HR = 1.44; 95% CI, 1.29–1.62), and severe malnutrition (HR = 1.79; 95% CI, 1.58–2.02) with all‐cause mortality. Sensitivity analysis supported the robustness of these associations. The between‐study heterogeneity was low (all I2 < 50%), and study quality assessed with NOS was high (all scores > 6). The evidence quality according to the GRADE tool was very low. Conclusions Our meta‐analysis suggests a significant negative association of malnutrition, as defined by the GLIM, with overall survival in patients with cancer. However, definitive conclusions cannot be made, owing to the low quality of the source data.