Value of the Xpert MTB/RIF assay in diagnosis of presumptive pulmonary tuberculosis in general hospitals in China

Abstract

Objectives

To evaluate the value of Xpert MTB/RIF in the diagnosis of pulmonary tuberculosis (PTB) in general hospitals, which are usually where patients first visit.

Materials and methods

Presumptive PTB patients, based on imaging results, in a general hospital in China, were enrolled from August 2015 to April 2017. The sensitivity and specificity of four tuberculosis (TB) detection methods, including sputum smear, Xpert MTB/RIF, T-SPOT.TB and TB-DNA were studied. To predict the effectiveness of the methods, different combinations were assessed using the receiver operating characteristic (ROC) curve.

Results

283 PTB suspect patients were enrolled, 81 of which were diagnosed as TB infections based on the golden standard. The TB detection rate for sputum smear was 11.7% (33/283). The respective sensitivity and specificity of Xpert MTB/RIF were 87.8% (71/81) and 99.5% (201/202). For the smear negative TB patients, the sensitivity of Xpert MTB/RIF was 79.2% (38/48). Combined with several methods, the Xpert MTB/RIF assay had the highest area under curve (AUC) value (0.913).

Conclusions

Xpert MTB/RIF showed tremendous promise for early, rapid and accurate diagnosis of TB. Multicentre evaluation and adoption of Xpert MTB/RIF in general hospitals in China should be embraced and promoted in order to establish an effective TB identification system.