{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:08:14Z","timestamp":1793502494370,"version":"4.5.0"},"reference-count":98,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T00:00:00Z","timestamp":1657497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Objective<\/jats:title><jats:p>We compared diagnostic accuracy of pleural fluid Xpert MTB\/RIF (Xpert) and Xpert MTB\/RIF Ultra (Ultra) assays for diagnosing tuberculous pleural effusion (TPE), through systematic review and comparative meta-analysis.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>We searched PubMed and Embase databases for publications reporting diagnostic accuracy of Xpert or Ultra for TPE. We used bivariate random-effects modeling to summarize diagnostic accuracy information from individual studies using either mycobacterial culture or composite criteria as reference standard. We performed meta-regression through hierarchical summary receiver operating characteristic (HSROC) modeling to evaluate comparative performance of the two tests from studies reporting diagnostic accuracy of both in the same study population.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>We retrieved 1097 publications, and included 74 for review. Summary estimates for sensitivity and specificity for Xpert were 0.52 (95% CI 0.43\u20130.60,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>82.1%) and 0.99 (95% CI 0.97\u20130.99,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>85.1%), respectively, using culture-based reference standard; and 0.21 (95% CI 0.17\u20130.26,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>81.5%) and 1.00 (95% CI 0.99\u20131.00,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>37.6%), respectively, using composite reference standard. Summary estimates for sensitivity and specificity for Ultra were 0.68 (95% CI 0.55\u20130.79,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>80.0%) and 0.97 (95% CI 0.97\u20130.99,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>92.1%), respectively, using culture-based reference standard; and 0.47 (95% CI 0.40\u20130.55,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>64.1%) and 0.98 (95% CI 0.95\u20130.99,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>54.8%), respectively, using composite reference standard. HSROC meta-regression yielded relative diagnostic odds ratio of 1.28 (95% CI 0.65\u20132.50) and 1.80 (95% CI 0.41\u20137.84) respectively in favor of Ultra, using culture and composite criteria as reference standard.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Ultra provides superior diagnostic accuracy over Xpert for diagnosing TPE, mainly because of its higher sensitivity.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0268483","type":"journal-article","created":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T17:28:25Z","timestamp":1657560505000},"page":"e0268483","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":31,"title":["Xpert MTB\/RIF Ultra versus Xpert MTB\/RIF for diagnosis of tuberculous pleural effusion: A systematic review and comparative meta-analysis"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8556-3600","authenticated-orcid":true,"given":"Ashutosh Nath","family":"Aggarwal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritesh","family":"Agarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3199-9163","authenticated-orcid":true,"given":"Sahajal","family":"Dhooria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuruswamy Thurai","family":"Prasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inderpaul Singh","family":"Sehgal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valliappan","family":"Muthu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,7,11]]},"reference":[{"issue":"9781849841160","key":"pone.0268483.ref001","first-page":"172","article-title":"Effusions related to TB","volume":"2020","author":"JA Shaw","year":"2020","journal-title":"ERS Monograph"},{"issue":"3","key":"pone.0268483.ref002","doi-asserted-by":"crossref","first-page":"e0213728","DOI":"10.1371\/journal.pone.0213728","article-title":"Adenosine deaminase for diagnosis of tuberculous pleural effusion: A systematic review and meta-analysis","volume":"14","author":"AN Aggarwal","year":"2019","journal-title":"PLoS One"},{"issue":"5","key":"pone.0268483.ref003","doi-asserted-by":"crossref","first-page":"e02112","DOI":"10.1128\/JCM.02112-20","article-title":"Unstimulated pleural fluid interferon gamma for diagnosis of tuberculous pleural effusion: a systematic review and meta-analysis","volume":"59","author":"AN Aggarwal","year":"2021","journal-title":"J Clin Microbiol"},{"issue":"6","key":"pone.0268483.ref004","article-title":"Xpert MTB\/RIF and Xpert MTB\/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults","volume":"6","author":"DJ Horne","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"pone.0268483.ref005","first-page":"CD012768","article-title":"Xpert MTB\/RIF Ultra and Xpert MTB\/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adult","volume":"1","author":"M Kohli","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"pone.0268483.ref006","doi-asserted-by":"crossref","first-page":"e00812","DOI":"10.1128\/mBio.00812-17","article-title":"The new Xpert MTB\/RIF Ultra: Improving detection of Mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing","volume":"8","author":"S Chakravorty","year":"2017","journal-title":"mBio"},{"key":"pone.0268483.ref007","volume-title":"Module 3: diagnosis\u2014rapid diagnostics for tuberculosis detection, 2021 update","author":"World Health Organization","year":"2021"},{"issue":"2","key":"pone.0268483.ref008","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1183\/09031936.00007814","article-title":"Xpert MTB\/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis","volume":"44","author":"CM Denkinger","year":"2014","journal-title":"Eur Respir J"},{"issue":"4","key":"pone.0268483.ref009","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1128\/JCM.03205-15","article-title":"Diagnostic performance of Xpert MTB\/RIF in tuberculous pleural effusion: Systematic review and meta-analysis","volume":"54","author":"IS Sehgal","year":"2016","journal-title":"J Clin Microbiol"},{"issue":"1","key":"pone.0268483.ref010","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s12879-018-3196-4","article-title":"Is Xpert MTB\/RIF appropriate for diagnosing tuberculous pleurisy with pleural fluid samples?","volume":"18","author":"ZY Huo","year":"2018","journal-title":"A systematic review. 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