Bozdemir Tuğba, Daloğlu Aylin Erman, Çolak Dilek, Gürkan Nazlı, Öngüt Gözde, Mutlu Derya
Bursa City Hospital, Medical Microbiology Laboratory, Bursa, Türkiye.
Antalya Training and Research Hospital, Medical Microbiology Laboratory, Antalya, Türkiye.
Mikrobiyol Bul. 2024 Jul;58(3):284-292. doi: 10.5578/mb.20249727.
Viral load monitoring is important in identifying patients at risk of developing cytomegalovirus (CMV) related complications after transplantation and for this purpose, quantitative real-time polymerase chain reaction (Rt-qPCR) tests are most commonly used. The main problem in CMV DNA Rt-qPCR tests that make quantitative measurements is that there are significant differences in measurements performed with different kits in different laboratories. Comparability of viral load measurements between laboratories has increased with the introduction of quantitative PCR tests calibrated with the CMV International Quantitation Standard (IQS) developed by the World Health Organization (WHO). However, quantitative agreement between measurements made with different kits has still not been fully achieved. In this study, it was aimed to investigate the quantitative compatibility between measurements made with Cobas 6800 (Roche Diagnostics, Mannheim, Germany) and NeuMoDx (Qiagen, Ann Arbor, USA) CMV DNA Rt-qPCR tests, which are fully automated new generation systems calibrated with the WHO CMV IQS. The results of 214 plasma samples, which were studied simultaneously with Cobas 6800 CMV Rt-qPCR and NeuMoDx CMV Rt-qPCR tests were analyzed. In the tests, the extraction, amplification and detection stages were carried out fully automatically. CMV DNA was detected in 144 (67.28%) samples in both tests and was not detected in 53 (24.76%) samples. Incompatible results were obtained in a total of 17 (7.94%) samples. Good agreement was found between the qualitative results of both tests (kappa= 0.80, p< 0.001). When the quantitative results (n= 129) obtained in the dynamic measurement range of both tests were examined, the median viral load values measured by Cobas 6800 CMV Rt-qPCR and NeuMoDx CMV Rt-qPCR tests were 513 IU/mL (range= 35-37000) and 741 IU/mL (range= 68-48978), respectively. According to the correlation analysis, a very strong correlation was found between the results of both tests (r= 0.94, p< 0.001). According to Bland-Altman analysis; the average difference between the results of the NeuMoDx CMV Rt-qPCR test and the Cobas 6800 CMV Rt-qPCR test was found to be -0.14 log10 [standard deviation (SD)= 0.23] IU/mL and it was determined that the Cobas 6800 CMV Rt-qPCR test had lower measurements than the NeuMoDx CMV Rt-qPCR test. In 120 of 129 samples (93%) whose results were within the dynamic measurement range of both tests, the measurement difference was within ± 0.5 log10 IU/mL and in 9 (7%), it was detected as more than ± 0.5 log10 (median 0.54 log10 IU/ml; range= 0.51-0.81). No measurement difference of more than ± 1.0 log10 was detected in any sample. In this study, quantitative agreement was found in the measurements made in plasma samples with the fully automated Cobas 6800 CMV Rt-qPCR and NeuMoDx CMV Rt-qPCR tests calibrated with the CMV IQS. To the best of our knowledge, a study comparing viral load measurements made with Cobas 6800 and NeuMoDx fully automated systems in the detection of CMV DNA has not yet been conducted, and this is the first study on this subject.
病毒载量监测对于识别移植后有发生巨细胞病毒(CMV)相关并发症风险的患者很重要,为此,定量实时聚合酶链反应(Rt-qPCR)检测最为常用。CMV DNA Rt-qPCR检测进行定量测量时的主要问题是,不同实验室使用不同试剂盒进行的测量存在显著差异。随着采用世界卫生组织(WHO)制定的CMV国际定量标准(IQS)校准的定量PCR检测方法的引入,各实验室之间病毒载量测量的可比性有所提高。然而,不同试剂盒测量结果之间的定量一致性仍未完全实现。本研究旨在调查使用Cobas 6800(德国曼海姆罗氏诊断公司)和NeuMoDx(美国安阿伯凯杰公司)CMV DNA Rt-qPCR检测方法进行测量的定量兼容性,这两种检测方法是采用WHO CMV IQS校准的新一代全自动系统。分析了同时采用Cobas 6800 CMV Rt-qPCR和NeuMoDx CMV Rt-qPCR检测方法研究的214份血浆样本的结果。在检测中,提取、扩增和检测阶段均全自动进行。两种检测方法在144份(67.28%)样本中均检测到CMV DNA,在53份(24.76%)样本中未检测到。总共17份(7.94%)样本获得了不兼容的结果。两种检测方法的定性结果之间具有良好的一致性(kappa = 0.80,p < 0.001)。检查两种检测方法动态测量范围内获得的定量结果(n = 129)时,Cobas 6800 CMV Rt-qPCR和NeuMoDx CMV Rt-qPCR检测方法测得的病毒载量中位数分别为513 IU/mL(范围 = 35 - 37000)和741 IU/mL(范围 = 68 - 48978)。根据相关性分析,两种检测方法的结果之间存在非常强的相关性(r = 0.94,p < 0.001)。根据Bland-Altman分析;发现NeuMoDx CMV Rt-qPCR检测方法和Cobas 6800 CMV Rt-qPCR检测方法结果的平均差异为 -0.14 log10 [标准差(SD)= 0.23] IU/mL,并且确定Cobas 6800 CMV Rt-qPCR检测方法的测量值低于NeuMoDx CMV Rt-qPCR检测方法。在两种检测方法动态测量范围内结果的129份样本中的120份(93%)中,测量差异在± 0.5 log10 IU/mL以内,9份(7%)样本中检测到差异超过± 0.5 log10(中位数0.54 log10 IU/ml;范围 = 0.51 - 0.81)。在任何样本中均未检测到超过± 1.0 log10的测量差异。在本研究中,采用经CMV IQS校准的全自动Cobas 6800 CMV Rt-qPCR和NeuMoDx CMV Rt-qPCR检测方法对血浆样本进行测量时发现了定量一致性。据我们所知,尚未进行过比较使用Cobas 6800和NeuMoDx全自动系统检测CMV DNA时病毒载量测量结果的研究,这是关于该主题的第一项研究。