Prevalence of indeterminate tuberculosis interferon‐gamma release assays in COVID‐19 patients: Systematic review and meta‐analysis

Abstract

Abstract Background and Aims The reliability of interferon‐gamma‐release‐assays (IGRAs) for tuberculosis (TB) testing in coronavirus disease 2019 (COVID‐19) patients is unknown. This study aimed to systematically review the prevalence of indeterminate TB‐IGRA following SARS‐CoV‐2 infection or vaccination and to review associated factors. Methods This systematic literature review was guided according to the PRISMA guidelines by searching PubMed, Scopus, Web of Science, Clinicalkey, and Cochrane Library. Studies reporting results of TB‐IGRA tests (QuantiFERON [QFT]‐TB, T‐SPOT.TB) in COVID‐19 patients or vaccines were included. The random effects model was used to assess the prevalence of indeterminate IGRA results. Heterogeneity was evaluated using the Τ 2 and 95% predictive interval. Results Of the 273 citations screened, 12 articles were included in the final analysis including a total of 2107 patients. The overall pooled effect size proportion of indeterminate QFT‐TB results, estimated in eight studies using the QFT‐TB Plus assay, was 0.26 (95% CI: 0.205−0.324, Τ 2 = 0.158). The mean true effect size was 0.26 (95% predictive interval: [0.110−0.500]). A subgroup analysis was not undertaken due to the small number of studies. Indeterminate QFT‐TB rates were associated with COVID‐19 severity, steroid treatment, inflammation‐related parameters, neutrophilia, and lymphopenia. Conclusion Indeterminate QFT‐TB results in COVID‐19 patients occur in almost one‐quarter of tests performed. Further studies are needed to assess associated factors.