The diagnostic value of T cell spot test and adenosine deaminase in pleural effusion for tuberculous pleurisy: A systematic review and meta-analysis

Background: Tuberculous infection of T cell spot test (T-SPOT.TB) and adenosine deaminase (ADA) have a high diagnostic value in pleural effusion for tuberculous pleurisy. However, there were major differences in existing research in regard to the clinical application of the two trials. Therefore, we conducted a meta-analysis to systematically evaluate the diagnostic value of T-SPOT.TB and ADA.

Methods: Pubmed, Web of Science and Embase databases were searched to compare diagnosis of tuberculous pleurisy by T-SPOT.TB and ADA. The search period was from inception to August 31, 2021. Statistical analyses were performed using Meta-disc 1.4, Revman 5.4 and Stata 16.0. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic (SROC) curves and the area under the curve (AUC) were used to summarize overall diagnostic performance.

Results: 10 qualified original research studies were included, with a total of 2075 patients, of which were 1391 tuberculous pleurisy and 684 non-tuberculous pleurisy. The pooled estimates of diagnostic accuracy of T-SPOT.TB were as follows: sensitivity, 0.88 (95% CI: 0.86-0.90; I² = 92.7%); specificity, 0.79 (95% CI: 0.76-0.82; I² = 93.7%); PLR, 4.49 (95% CI: 2.29-8.80; I² = 94.9%); NLR, 0.15 (95% CI: 0.08-0.30; I² = 94.3%), DOR, 35.72 (95% CI: 11.15-114.47; I² = 91.5%). The AUC for SROC was 0.9283 (95% CI: 0.8912-0.9654). The pooled estimates of diagnostic accuracy of ADA were as follows: sensitivity, 0.65 (95% CI: 0.62-0.67; I² = 98.2%); specificity, 0.90 (95% CI: 0.88-0.92; I² = 69.4%); PLR, 6.12 (95% CI: 4.71-7.96; I² = 11.9%); NLR, 0.33 (95% CI: 0.12-0.89; I² = 99.5%), DOR, 23.18 (95% CI: 12.75-42.14; I² = 66.7%). The AUC for SROC was 0.9208 (95% CI: 0.9029-0.9387).

Conclusion: Both T-SPOT.TB and ADA had high value in the diagnosis of tuberculous pleurisy. The sensitivity of T-SPOT.TB was higher than ADA, but the specificity of ADA was higher than T-SPOT.TB. On the whole, T-SPOT. TB had similar diagnostic accuracy to ADA.