Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Clin Microbiol. 2021 Apr 20;59(5). doi: 10.1128/JCM.02112-20.
Unstimulated interferon gamma may be a useful pleural fluid biomarker in the diagnosis of tuberculous pleural effusion (TPE). However, the exact threshold of pleural fluid interferon gamma and its accuracy during routine clinical decision-making is not clear. We assessed the performance of pleural fluid interferon gamma in diagnosing TPE and tried to identify a useful assay threshold. We queried the PubMed and Embase databases for publications indexed until May 2020 that provided both sensitivity and specificity data on unstimulated pleural fluid interferon gamma for diagnosis of TPE. A bivariate random effects model was employed to compute summary estimates for diagnostic accuracy parameters, both overall as well as at threshold ranges of <2, 2 to 5, and >5 IU/ml. We retrieved 2,048 citations, of which 67 publications (7,153 patients) were assessed in our review. The summary estimates for sensitivity, specificity, and diagnostic odds ratio were 0.93 (95% confidence interval [CI], 0.91 to 0.95), 0.96 (95% CI, 0.94 to 0.97), and 310.72 (95% CI, 185.24 to 521.18), respectively. Increasing interferon gamma thresholds did not translate into any substantial change in diagnostic performance; however, eight studies using thresholds of >5 IU/ml showed poorer diagnostic accuracy estimates than other studies with lower thresholds. None of the prespecified subgroup variables significantly influenced relative diagnostic odds ratios in a multivariate meta-regression model. All publications demonstrated a high risk of bias. Unstimulated pleural fluid interferon gamma level provides excellent accuracy for diagnosing TPE and has the potential of becoming a first-line test for this purpose.
未刺激干扰素 γ 可能是诊断结核性胸腔积液（TPE）的有用胸腔液生物标志物。然而，在常规临床决策中，胸腔液干扰素 γ 的确切阈值及其准确性尚不清楚。我们评估了胸腔液干扰素 γ 在诊断 TPE 中的性能，并试图确定一个有用的检测阈值。我们在 PubMed 和 Embase 数据库中检索了截至 2020 年 5 月的文献，这些文献提供了未刺激胸腔液干扰素 γ 用于诊断 TPE 的敏感性和特异性数据。我们采用双变量随机效应模型计算了诊断准确性参数的汇总估计值，包括总体和<2、2 至 5 和>5 IU/ml 的阈值范围内的汇总估计值。我们检索到 2048 条引文，其中 67 篇文献（7153 例患者）纳入我们的综述。敏感性、特异性和诊断比值比的汇总估计值分别为 0.93（95%置信区间 [CI]，0.91 至 0.95）、0.96（95% CI，0.94 至 0.97）和 310.72（95% CI，185.24 至 521.18）。干扰素 γ 阈值的升高并没有导致诊断性能的实质性变化；然而，八项使用>5 IU/ml 阈值的研究显示出比其他使用较低阈值的研究较差的诊断准确性估计值。在多变量荟萃回归模型中，没有一个预设的亚组变量显著影响相对诊断比值比。所有出版物都显示出高度的偏倚风险。未刺激的胸腔液干扰素 γ 水平对诊断 TPE 具有出色的准确性，并且有可能成为该目的的一线检测方法。
