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Diagnostic accuracy of tumor necrosis factor-alpha assay for tuberculous pleurisy

View Article: PubMed Central - PubMed

ABSTRACT

Background:: The diagnosis of tuberculous pleurisy is difficult and traditional methods are not always helpful. Many studies have focused on the tumor necrosis factor-alpha (TNF-α) assay in pleural effusion for the diagnosis of tuberculous pleurisy, but the results remain controversial. This meta-analysis was conducted to determine the overall diagnostic accuracy of TNF-α.

Methods:: Relevant studies were searched from PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wangfang, and Weipu. We pooled the published results and computed the accuracy measures, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Receiver operating characteristic curves (SROC) and the area under the curve (AUC) were used to summarize the overall test performance.

Results:: Twelve studies with 1022 patients met the inclusion criteria. The pooled sensitivity and specificity were 0.85 (95%CI, 0.81–0.89) and 0.80 (95% CI, 0.77–0.83) respectively. The area under the SROC curve was 0.89.

Conclusions:: The results of meta-analysis suggested that the TNF-α assay plays a vital role in the diagnosis of tuberculous pleurisy, whereas other test results or clinical findings should be interpreted together with the TNF-α assay to improve the overall diagnostic accuracy.

No MeSH data available.


Related in: MedlinePlus

Methodological quality assessment of studies of the TNF-αassay. (A) Graph of risk of bias and applicability concerns. (B) Summary of risk bias and applicability concerns. TNF-α = tumor necrosis factor-alpha.
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Figure 2: Methodological quality assessment of studies of the TNF-αassay. (A) Graph of risk of bias and applicability concerns. (B) Summary of risk bias and applicability concerns. TNF-α = tumor necrosis factor-alpha.

Mentions: In our meta-analysis, the average sample size of the included studies was 85 (range 50–127). Diagnosis of TPE in 7 studies was made based upon histological or bacteriological confirmation, which are considered “gold standard.”[28,31–34,36,37] Whereas in the other remaining 5 studies, TPE patients were diagnosed based upon “gold standard” or on their clinical course which included clinical presentation, pleural fluid analysis, radiology, and the responsiveness to anti-tuberculous therapy.[24–27,35] All the included studies mentioned the TNF-α assay method. One study used the RIA assay as the test method,[23] whereas the remaining 11 studies used ELISA assay. Among the 12 included studies, 2 studies reported blinded interpretation of TNF-α assay independent of the reference standard.[35,36] All the studies except 4[24–27] were designed as prospective studies. The clinical characteristics and other information are outlined in Table 1. By the QUADAS-2 tool, it was found that the quality of studies for our research was generally good. The results are presented in Fig. 2A and B.


Diagnostic accuracy of tumor necrosis factor-alpha assay for tuberculous pleurisy
Methodological quality assessment of studies of the TNF-αassay. (A) Graph of risk of bias and applicability concerns. (B) Summary of risk bias and applicability concerns. TNF-α = tumor necrosis factor-alpha.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134804&req=5

Figure 2: Methodological quality assessment of studies of the TNF-αassay. (A) Graph of risk of bias and applicability concerns. (B) Summary of risk bias and applicability concerns. TNF-α = tumor necrosis factor-alpha.
Mentions: In our meta-analysis, the average sample size of the included studies was 85 (range 50–127). Diagnosis of TPE in 7 studies was made based upon histological or bacteriological confirmation, which are considered “gold standard.”[28,31–34,36,37] Whereas in the other remaining 5 studies, TPE patients were diagnosed based upon “gold standard” or on their clinical course which included clinical presentation, pleural fluid analysis, radiology, and the responsiveness to anti-tuberculous therapy.[24–27,35] All the included studies mentioned the TNF-α assay method. One study used the RIA assay as the test method,[23] whereas the remaining 11 studies used ELISA assay. Among the 12 included studies, 2 studies reported blinded interpretation of TNF-α assay independent of the reference standard.[35,36] All the studies except 4[24–27] were designed as prospective studies. The clinical characteristics and other information are outlined in Table 1. By the QUADAS-2 tool, it was found that the quality of studies for our research was generally good. The results are presented in Fig. 2A and B.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: The diagnosis of tuberculous pleurisy is difficult and traditional methods are not always helpful. Many studies have focused on the tumor necrosis factor-alpha (TNF-α) assay in pleural effusion for the diagnosis of tuberculous pleurisy, but the results remain controversial. This meta-analysis was conducted to determine the overall diagnostic accuracy of TNF-α.

Methods:: Relevant studies were searched from PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wangfang, and Weipu. We pooled the published results and computed the accuracy measures, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Receiver operating characteristic curves (SROC) and the area under the curve (AUC) were used to summarize the overall test performance.

Results:: Twelve studies with 1022 patients met the inclusion criteria. The pooled sensitivity and specificity were 0.85 (95%CI, 0.81–0.89) and 0.80 (95% CI, 0.77–0.83) respectively. The area under the SROC curve was 0.89.

Conclusions:: The results of meta-analysis suggested that the TNF-α assay plays a vital role in the diagnosis of tuberculous pleurisy, whereas other test results or clinical findings should be interpreted together with the TNF-α assay to improve the overall diagnostic accuracy.

No MeSH data available.


Related in: MedlinePlus