Risk of progression to active tuberculosis for indeterminate interferon-gamma release assay in immunocompromised individuals: a systematic review and meta-analysis

Guozhong Zhou; Shiqi Luo; Jian He; Nan Chen; Yu Zhang; Shunli Cai; Xin Guo; Chao Song

doi:10.1016/j.cmi.2023.07.003

Risk of progression to active tuberculosis for indeterminate interferon-gamma release assay in immunocompromised individuals: a systematic review and meta-analysis

Clin Microbiol Infect. 2023 Jul 6:S1198-743X(23)00308-7. doi: 10.1016/j.cmi.2023.07.003. Online ahead of print.

Authors

Guozhong Zhou¹, Shiqi Luo², Jian He³, Nan Chen⁴, Yu Zhang⁴, Shunli Cai⁵, Xin Guo⁵, Chao Song⁶

Affiliations

¹ Department of Science and Research, The Affiliated Anning First People's Hospital of Kunming University of Science and Technology, Kunming, Yunnan Province, China.
² Department of Immunology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
³ Department of Pulmonary and Critical Care Medicine, The Affiliated Anning First People's Hospital of Kunming University of Science and Technology, Kunming, Yunnan Province, China.
⁴ Department of Endocrinology, The Affiliated Anning First People's Hospital of Kunming University of Science and Technology, Kunming, Yunnan Province, China.
⁵ School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan Province, China.
⁶ Department of Medical Imaging, The Affiliated Anning First People's Hospital of Kunming University of Science and Technology, Kunming, Yunnan Province, China. Electronic address: chaoge6870@163.com.

PMID: 37422080
DOI: 10.1016/j.cmi.2023.07.003

Abstract

Background: Limited data exist on assessing the risk of active tuberculosis (TB) in immunocompromised individuals during screening for latent tuberculosis infection (LTBI).

Objectives: To assess the risk of progression to active TB for indeterminate interferon-γ release assays (IGRA) results in immunocompromised individuals during screening for LTBI.

Data sources: PubMed, Embase, Web of Science, and the Cochrane Library were searched without start date or language restrictions on 18 April 2023.

Study eligibility criteria: Cohort study or randomized controlled trials that investigated the risk of progression to active TB for indeterminate IGRA during LTBI screening.

Participants: Immunocompromised individuals. TEST: IGRA (T-SPOT.TB and QuantiFERON).

Reference standard: None.

Assessment of risk of bias: A modified version of the Newcastle-Ottawa Scale.

Methods of data synthesis: Fixed effects meta-analysis was used to obtain two pooled risk ratios (RRs). RR-ip represented disease progression rate in untreated individuals with indeterminate IGRA versus positive IGRA. RR-in represented disease progression rate in untreated individuals with indeterminate IGRA versus negative IGRA.

Results: Among the 5102 identified studies, 28 (14 792 immunocompromised individuals) were included. The pooled RR-ip and RR-in for cumulative incidence were 0.51 (95% CI, 0.32-0.82; I² = 0%) and 2.94 (95% CI, 1.78-4.85; I² = 0%), respectively. In addition, 11 studies reporting person-year data were included to verify the reliability of cumulative incidence results. The pooled RR-ip and RR-in for person-year incidence were 0.40 (95% CI, 0.19-0.82; I² = 13%) and 2.67 (95% CI, 1.24-5.79; I² = 23%), respectively.

Discussion: Indeterminate IGRA results in immunocompromised individuals may represent an intermediate risk of progression to active TB, with half the risk for positive results and three times for negative results. Proper follow-up and management of patients with indeterminate results are crucial for mitigating progression risk and improving patient outcomes.

Keywords: Indeterminate; Interferon-γrelease assay; Latent tuberculosis infection; Meta-analysis; Progression.

Publication types

Review