Diagnostic Accuracy of Interferon-Gamma Release Assays for Tuberculous Meningitis: A Systematic Review and Meta-Analysis

Abstract

BackgroundIn this study, we evaluated and compared the accuracy of blood and cerebrospinal fluid (CSF) interferon release tests [interferon-gamma release assays (IGRAs)] in the diagnosis of tuberculous meningitis (TBM) by a meta-analysis of the relevant literature.MethodsWe searched for studies published before 2021 in Medline, Embase, the Cochrane database, and Chinese databases. All studies used the QuantiFERON-TB Gold In-Tube and/or T-SPOT.TB method. Blood and/or CSF tests that met the guidelines for the quality assessment of studies with diagnostic accuracy were included. We used the revised diagnostic accuracy study quality assessment to assess the quality of the included studies. Begg’s funnel plots were used to assess publication bias in the meta-analysis of the diagnostic studies, and statistical analyses were performed by using Stata (Version 12) software.ResultsA total of 12 blood and/or CSF IGRA studies were included in this meta-analysis, with 376 patients and 493 controls. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve (SROC) of the blood IGRAs in the pooled data from 12 studies were 74% (95% CI: 0.65-0.82), 78% (95% CI: 0.68-0.86), 3.38 (95% CI 2.26-5.06), 0.33 (95% CI: 0.23-0.46), 10.25 (95% CI: 5.46-19.25), and 0.83 (95% CI: 0.79-0.86), respectively. For CSF IGRAs, these values for the pooled data from the 10 studies included were 79% (95% CI: 0.71-0.85), 95% (95% CI: 0.88-0.98), 16.30 (95% CI 6.5-40.83), 0.22 (95% CI: 0.16-0.31), 57.93 (95% CI: 22.56-148.78), and 0.91 (95% CI: 0.88-0.93), respectively.ConclusionCSF IGRAs exhibited a better diagnostic accuracy than blood IGRAs in diagnosing TBM.

Cerebral tuberculoma in pregnant women: A systematic review and comprehensive analysis of literature

“…Our review found that all patients tested positive for the CSF IGRA assay, underscoring its superior diagnostic e cacy. In comparison, a previous meta-analysis on CSF IGRAs in non-pregnant patients reported a pooled sensitivity of 79% (95% CI: 0.71-0.85) and a speci city of 95% (95% CI: 0.88-0.98), demonstrating its high diagnostic performance 53 . However, it is critical to note that blood samples must be processed within 8-30 hours post-collection for viability, and a positive result does not necessarily indicate active disease.…”

A systematic review and meta-analysis of the diagnostic accuracy of metagenomic next-generation sequencing for diagnosing tuberculous meningitis

“…Interferon-gamma release assays (IGRAs) are used to detect the presence of MTB infection by measuring the amount of interferon (IFN)-gamma released by T cells after stimulation with MTB-specific antigens and the number of T cells releasing IFN-gamma ( 44 ). A meta-analysis showed that the overall sensitivity and specificity of IGRA 74% and 79%, respectively, in blood, and 78% and 95%, respectively, in CSF, suggesting moderate accuracy in the diagnosis of TBM ( 35 , 36 ). However, IGRA is not effective at distinguishing between latent and active TB ( 45 , 46 ).…”

Exploring the pathogenesis linking traumatic brain injury and epilepsy via bioinformatic analyses

“…Interferon gamma is mainly involved in immune regulation, and its expression level is associated with neurological diseases ( Zhang et al, 2020 ; Döhne et al, 2022 ; Wen et al, 2022 ). TBI could induce a serial of cytokines, including interferon gamma and activate various types of immune cells ( Siwicka-Gieroba and Dabrowski, 2021 ; Salem et al, 2022 ).…”