Interferon-γ release assays for tuberculous meningitis diagnosis: a meta-analysis

Area of Science:

• Infectious Diseases
• Microbiology
• Diagnostics

Background:

• Tuberculous meningitis (TBM) poses a significant global health challenge.
• Conventional diagnostic methods for TBM are often unsatisfactory.
• Interferon-γ release assays (IGRAs) have been explored for TBM diagnosis, but their utility remains unclear.

Purpose of the Study:

• To systematically evaluate the diagnostic performance of IGRAs in cerebrospinal fluid (CSF) and peripheral blood (PB) for TBM.
• To clarify the role of IGRAs in TBM diagnosis through a comprehensive meta-analysis.

Main Methods:

• A systematic search of relevant studies was conducted in international and Chinese databases up to March 2018.
• Studies meeting microbiological or clinical criteria for TBM diagnosis were included.
• Diagnostic accuracy measures (sensitivity, specificity, PLR, NLR, DOR) were pooled using random effects models, with heterogeneity assessed via meta-regression and subgroup analyses.

Main Results:

• The meta-analysis included 26 studies with 1892 participants.
• Pooled sensitivity and specificity for PB IGRAs were 0.81 and 0.76, respectively.
• Pooled sensitivity and specificity for CSF IGRAs were 0.81 and 0.89, respectively, with a higher DOR (47.74) compared to PB IGRAs (21.06).

Conclusions:

• The overall diagnostic performance of IGRAs for TBM is suboptimal.
• IGRAs are currently unsuitable as biomarkers for TBM diagnosis considering factors like cost, turnaround time, and accessibility.