Comparison of QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for diagnosis of latent tuberculosis in haemodialysis (HD) patients: a meta-analysis ofκestimates

SUMMARYDiagnosis of latent tuberculosis infection (LTBI) is a concern in haemodialysis (HD) patients. Many studies have compared QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for detecting LTBI and reported theκstatistic of agreement between QFT-GIT and TST in HD patients. The present study aimed to systematically review this literature and conduct meta-analysis of individual studies that estimated theκbetween QFT-GIT with TST among HD patients. All relevant published studies that were available as full-text were obtained by searching Medline (1950), Web of Sciences (1945), Scopus (1973) through May 2016. Theκwas re-estimated from the individual studies and pooled using random effect meta-analysis. Subgroup analysis and meta-regression were applied to evaluate the effect of Bacillus Calmette–Guérin (BCG) vaccination, TST cut-off points, quality of studies, sample size and age on variation ofκestimate. Eight studies involving 901 HD patients were included in meta-analysis. The pooledκestimate was 0·28 (I2= 18·4%,P= 0·239, 95% confidence intervals 0·22–0·34). The discordance of TST−/QFT-GIT+ was more than TST+/QFT-GIT−. History of BCG vaccination, TST cut-off points and age are related to variation ofκestimates. TST and QFT-GIT are not comparable in detecting LTBI in HD patients. The higher TST−/QFT-GIT+ ratio compared with TST+/QFT-GIT− ratio, may indicate the superiority of QFT-GIT over TST for detection LTBI in HD patients.

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Screening for latent tuberculosis infection: performance of tuberculin skin test and interferon-γ release assays under real-life conditions

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2011-200941 ◽

2012 ◽

Vol 71 (11) ◽

pp. 1791-1795 ◽

Cited By ~ 45

Author(s):

S Kleinert ◽

H-P Tony ◽

K Krueger ◽

J Detert ◽

F Mielke ◽

...

Keyword(s):

Risk Factors ◽

Tuberculin Skin Test ◽

Skin Test ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Interferon Γ ◽

Clinical Risk Factors ◽

Test Results ◽

Bcg Vaccination ◽

Rheumatological Disease

ObjectivesTo characterise optimal screening strategies for latent tuberculosis infection (LTBI) prior to the initiation of anti-tumour necrosis factor therapy.MethodsPatients in 62 German rheumatology centres were evaluated for LTBI. Each patient was screened with a tuberculin skin test (TST) and one form of an interferon-γ release assay (IGRA), either TSPOT.TB (TSPOT) or Quantiferon TB Gold (QFT).ResultsA total of 1529 patients with rheumatological disease were tested with a TST, 844 with TSPOT and 685 with QFT. TST was positive in 11.3% (n=173). The prevalence of LTBI was 8.0% when defined as a positive TST and no previous Bacille Calmette-Guérin (BCG) vaccination and 7.9% when based on a positive IGRA. Combining both estimates increased the prevalence of LTBI to 11.1%. Clinical risk factors for LTBI were found in 122 patients (34 with a history of prior TB, 81 close contacts and 27 with suggestive chest x-ray lesions). A compound risk factor (CRF) was defined as the presence of at least one of these three risk factors. Statistical analyses were conducted to examine the association between CRF and LTBI test outcomes. In multivariate analysis, TST was influenced by CRF (OR 6.2; CI 4.08 to 9.44, p<0.001) and BCG vaccination status (OR 2.9; CI 2.00 to 4.35, p<0.001). QFT and TSPOT were only influenced by CRF (QFT: OR 2.6; CI 1.15 to 5.98, p=0.021; TSPOT: OR 8.7; CI 4.83 to 15.82, p<0.001). ORs and the agreement of TST and IGRA test results varied by rheumatological disease.ConclusionLTBI test results in an individual patient need to be considered in the context of prior BCG vaccination and clinical risk factors. In patient populations with low rates of TB incidence and BCG vaccination, the use of both TST and IGRA may maximise sensitivity in detecting LTBI but may also reduce specificity.

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