Diagnostic value comparative analysis of the commercial kits for the detection of SARS-CoV-2 in clinical samples: a systematic review and meta-analysis
Abstract
Background and Objectives: Rapid and accurate identification of suspicious SARS-CoV-2 patients is essential in controlling the infection. Numerous commercial kits are developed which target diverse regions of the SARS-CoV-2 virus genome. This systematic review addresses the lack of comprehensive analyses comparing the diagnostic value of commercial kits for SARS-CoV-2 detection. We aimed to compare diagnostic value of commercial SARS-CoV-2 kits in clinical samples using a systematic review and meta-analysis method.
Materials and Methods: A comprehensive search was conducted on main databases of Medline (PubMed), Embase, Web of Science and Scopus from 2019 to October 2021 using the appropriate keywords. Systematic Reviews and Meta-Analysis guideline PRISMA checklist was used to select eligible studies.
Results: The most frequent introduced kits were from USA (33 cases) and China (27). Among all studies, 11, 9 and 7 papers had assessed FDA –CDC, Sansure and Allplex kits, respectively. The majority of the kits were based on RT-PCR (52 cases) and the most frequent genes target was N protein (63 cases). The overall sensitivity of the kits was 80.5%. The lowest sensitivity was reported for Daan Kit, while the highest sensitivity was seen for many kits. The specificity of the kits ranged from 87.9% to 99.8% and the overall specificity was 97.9%. Both PPV and NPV of the kits ranged from 87.9% to 99.8% for PPV and 82.9% to 99.8% for NPV.
Conclusion: Based on DOR obtained from three different formulas, GeneFinder, InBios, NxTAG, Simplexa and FDA-CDC kit have better detection performance. The GeneFinder Kit appears to be among the more suitable options regarding cost-effectiveness for each reaction.
2. Syal K. Guidelines on newly identified limitations of diagnostic tools for COVID-19 and consequences. J Med Virol 2021; 93: 1837-1842.
3. Khailany RA, Safdar M, Ozaslan M. Genomic characterization of a novel SARS-CoV-2. Gene Rep 2020; 19: 100682.
4. Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC, et al. Diagnosing COVID-19: The Disease and Tools for Detection. ACS Nano 2020; 14: 3822-3835.
5. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, et al. Preferred reporting items for a systematic review and Meta-analysis of diagnostic test accuracy studies: The PRISMA-DTA statement. JAMA 2018; 319: 388-396.
6. Leeflang MM. Systematic reviews and meta-analyses of diagnostic test accuracy. Clin Microbiol Infect 2014; 20: 105-113.
7. Alaifan T, Altamimi A, Obeid D, Alshehri T, Almatrrouk S, Albarrag A. SARS-CoV-2 direct real-time polymerase chain reaction testing in laboratories with shortage challenges. Future Virol 2021; 16: 133-139.
8. Guo JJ, Yu YH, Ma XY, Liu YN, Fang Q, Qu P, et al. A multiple-center clinical evaluation of a new real-time reverse transcriptase PCR diagnostic kit for SARS-CoV-2. Future Virol 2020; 10.2217/fvl-2020-0299.
9. Freire-Paspuel B, Vega-Mariño P, Velez A, Cruz M, Perez F, Garcia-Bereguiain MA. Analytical and clinical comparison of Viasure (CerTest Biotec) and 2019-nCoV CDC (IDT) RT-qPCR kits for SARS-CoV2 diagnosis. Virology 2021; 555: 111.
10. Wang M, Chen D, Wu W, Tang H, Kan L, Zong Z, et al. Analytical performance evaluation of five RT-PCR kits for severe acute respiratory syndrome coronavirus 2. J Clin Lab Anal 2021; 35(1): e23643.
11. Goldenberger D, Leuzinger K, Sogaard KK, Gosert R, Roloff T, Naegele K, et al. Brief validation of the novel GeneXpert Xpress SARS-CoV-2 PCR assay. J Virol Methods 2020; 284: 113925.
12. Nagura-Ikeda M, Imai K, Tabata S, Miyoshi K, Murahara N, Mizuno T, et al. Clinical Evaluation of Self-Collected Saliva by Quantitative Reverse Transcription-PCR (RT-qPCR), Direct RT-qPCR, Reverse Transcription-Loop-Mediated Isothermal Amplification, and a Rapid Antigen Test To Diagnose COVID-19. J Clin Microbiol 2020; 58(9): e01438-20.
13. Chen JH, Yip CC, Chan JF, Poon RW, To KK, Chan KH, et al. Clinical Performance of the Luminex NxTAG CoV Extended Panel for SARS-CoV-2 Detection in Nasopharyngeal Specimens from COVID-19 Patients in Hong Kong. J Clin Microbiol 2020; 58(8): e00936-20.
14. Matsumura Y, Shimizu T, Noguchi T, Nakano S, Yamamoto M, Nagao M. Comparison of 12 Molecular detection assays for severe acute Respiratory syndrome Coronavirus 2 (SARS-CoV-2). J Mol Diagn 2021; 23: 164-170.
15. Zhen W, Manji R, Smith E, Berry GJ. Comparison of Four Molecular in vitro diagnostic assays for the detection of SARS-CoV-2 in Nasopharyngeal specimens. J Clin Microbiol 2020; 58(8): e00743-20.
16. van Kasteren PB, van der Veer B, van den Brink S, Wijsman L, de Jonge J, van den Brandt A, et al. Comparison of seven commercial RT-PCR diagnostic kits for COVID-19. J Clin Virol 2020; 128: 104412.
17. Lu Y, Li L, Ren S, Liu X, Zhang L, Li W, et al. Comparison of the diagnostic efficacy between two PCR test kits for SARS-CoV-2 nucleic acid detection. J Clin Lab Anal 2020; 34(10): e23554.
18. Pasomsub E, Watcharananan SP, Boonyawat K, Janchompoo P, Wongtabtim G, Suksuwan W, et al. Saliva sample as a non-invasive specimen for the diagnosis of coronavirus disease 2019: a cross-sectional study. Clin Microbiol Infect 2021; 27(2): 285.e1-285.e4.
19. Haq F, Sharif S, Khurshid A, Ikram A, Shabbir I, Salman M, et al. Reverse transcriptase loop-mediated isothermal amplification (RT-LAMP)-based diagnosis: A potential alternative to quantitative real-time PCR based detection of the novel SARS-COV-2 virus. Saudi J Biol Sci 2021; 28: 942-947.
20. Freire-Paspuel B, Garcia-Bereguiain MA. Poor sensitivity of "AccuPower SARS-CoV-2 real time RT-PCR kit (Bioneer, South Korea)". Virol J 2020; 17: 178.
21. Freire-Paspuel B, Garcia-Bereguiain MA. Low clinical performance of the Isopollo COVID-19 detection kit (M Monitor, South Korea) for RT-LAMP SARS-CoV-2 diagnosis: A call for action against low quality products for developing countries. Int J Infect Dis 2021; 104: 303-305.
22. Sarıgül F, Doluca O, Akhan S, Sayan M. Investigation of compatibility of severe acute respiratory syndrome coronavirus 2 reverse transcriptase-PCR kits containing different gene targets during coronavirus disease 2019 pandemic. Future Virol 2020; 15: 515-524.
23. Alcoba-Florez J, Gil-Campesino H, García-Martínez de Artola D, Díez-Gil O, Valenzuela-Fernández A, González-Montelongo R, et al. Increasing SARS-CoV-2 RT-qPCR testing capacity by sample pooling. Int J Infect Dis 2021; 103: 19-22.
24. Zou J, Zhi S, Chen M, Su X, Kang L, Li C, et al. Heat inactivation decreases the qualitative real-time RT-PCR detection rates of clinical samples with high cycle threshold values in COVID-19. Diagn Microbiol Infect Dis 2020; 98: 115109.
25. Visseaux B, Le Hingrat Q, Collin G, Ferré V, Storto A, Ichou H, et al. Evaluation of the RealStar® SARS-CoV-2 RT-PCR kit RUO performances and limit of detection. J Clin Virol 2020; 129: 104520.
26. Kitagawa Y, Orihara Y, Kawamura R, Imai K, Sakai J, Tarumoto N, et al. Evaluation of rapid diagnosis of novel coronavirus disease (COVID-19) using loop-mediated isothermal amplification. J Clin Virol 2020; 129: 104446.
27. Freire-Paspuel B, Vega-Mariño P, Velez A, Castillo P, Cruz M, Garcia-Bereguiain MA. Evaluation of nCoV-QS (MiCo BioMed) for RT-qPCR detection of SARS-CoV-2 from nasopharyngeal samples using CDC FDA EUA qPCR kit as a gold standard: An example of the need of validation studies. J Clin Virol 2020; 128: 104454.
28. Wen D, Yang S, Li G, Xuan Q, Guo W, Wu W. Sample-to-Answer and routine Real-Time RT-PCR: A comparison of different platforms for SARS-CoV-2 detection. J Mol Diagn 2021; 23: 665-670.
29. Sasaki T, Inoue O, Ogihara S, Kubokawa K, Oishi S, Shirai T, et al. Detection of SARS-CoV-2 RNA Using RT-qPCR in saliva samples and Nasopharyngeal, Lingual, and buccal mucosal swabs. Jpn J Infect Dis 2022; 75: 102-104.
30. Tedim AP, Almansa R, Domínguez-Gil M, González-Rivera M, Micheloud D, Ryan P, et al. Comparison of real-time and droplet digital PCR to detect and quantify SARS-CoV-2 RNA in plasma. Eur J Clin Invest 2021; 51(6): e13501.
31. Mollaei HR, Afshar AA, Kalantar-Neyestanaki D, Fazlalipour M, Aflatoonian B. Comparison five primer sets from different genome region of COVID-19 for detection of virus infection by conventional RT-PCR. Iran J Microbiol 2020; 12: 185-193.
32. Lee CJ, Shin W, Mun S, Yu M, Choi YB, Kim DH, et al. Diagnostic evaluation of qRT-PCR-based kit and dPCR-based kit for COVID-19. Genes Genomics 2021; 43: 1277-1288.
33. Hernández C, Florez C, Castañeda S, Ballesteros N, Martínez D, Castillo A, et al. Evaluation of the diagnostic performance of nine commercial RT-PCR kits for the detection of SARS-CoV-2 in Colombia. J Med Virol 2021; 93: 5618-5622.
34. Chung YS, Lee NJ, Woo SH, Kim JM, Kim HM, Jo HJ, et al. Validation of real-time RT-PCR for detection of SARS-CoV-2 in the early stages of the COVID-19 outbreak in the Republic of Korea. Sci Rep 2021; 11: 14817.
35. Roy S, Paul SK, Barman TK, Ahmed S, Haque N, Mazid R, et al. SARS-CoV-2 Detection using Real Time PCR by a Commercial Diagnostic Kit. Mymensingh Med J 2020; 29: 596-600.
36. Fukumoto T, Iwasaki S, Fujisawa S, Hayasaka K, Sato K, Oguri S, et al. Efficacy of a novel SARS-CoV-2 detection kit without RNA extraction and purification. Int J Infect Dis 2020; 98: 16-17.
37. Freire-Paspuel B, Garcia-Bereguiain MA. Analytical and Clinical Evaluation of "AccuPower SARS-CoV-2 Multiplex RT-PCR kit (Bioneer, South Korea)" and "Allplex 2019-nCoV Assay (Seegene, South Korea)" for SARS-CoV-2 RT-PCR Diagnosis: Korean CDC EUA as a Quality control proxy for developing countries. Front Cell Infect Microbiol 2021; 11: 630552.
38. Reijns MAM, Thompson L, Acosta JC, Black HA, Sanchez-Luque FJ, Diamond A, et al. A sensitive and affordable multiplex RT-qPCR assay for SARS-CoV-2 detection. PLoS Biol 2020; 18(12): e3001030.
39. Freire-Paspuel B, Garcia-Bereguiain MA. Clinical Performance and analytical sensitivity of three SARS-CoV-2 Nucleic acid diagnostic tests. Am J Trop Med Hyg 2021; 104: 1516-1518.
40. Lu R, Wu X, Wan Z, Li Y, Jin X, Zhang C. A novel reverse transcription Loop-Mediated isothermal Amplification method for rapid detection of SARS-CoV-2. Int J Mol Sci 2020; 21: 2826.
41. Hur KH, Park K, Lim Y, Jeong YS, Sung H, Kim MN. Evaluation of four commercial kits for SARS-CoV-2 Real-Time Reverse-Transcription Polymerase Chain Reaction Approved by Emergency-Use-Authorization in Korea. Front Med (Lausanne) 2020; 7: 521.
42. Tsang HF, Leung WMS, Chan LWC, Cho WCS, Wong SCC. Performance comparison of the Cobas® Liat® and Cepheid® GeneXpert® systems on SARS-CoV-2 detection in nasopharyngeal swab and posterior oropharyngeal saliva. Expert Rev Mol Diagn 2021; 21: 515-518.
43. Moore NM, Li H, Schejbal D, Lindsley J, Hayden MK. Comparison of two commercial Molecular tests and a Laboratory-Developed Modification of the CDC 2019-nCoV Reverse Transcriptase PCR Assay for the detection of SARS-CoV-2. J Clin Microbiol 2020; 58(8): e00938-20.
44. Gupta E, Padhi A, Khodare A, Agarwal R, Ramachandran K, Mehta V, et al. Pooled RNA sample reverse transcriptase real time PCR assay for SARS CoV-2 infection: A reliable, faster and economical method. PLoS One 2020; 15(7): e0236859.
45. Schermer B, Fabretti F, Damagnez M, Di Cristanziano V, Heger E, Arjune S, et al. Rapid SARS-CoV-2 testing in primary material based on a novel multiplex RT-LAMP assay. PLoS One 2020; 15(11): e0238612.
46. Szymczak WA, Goldstein DY, Orner EP, Fecher RA, Yokoda RT, Skalina KA, et al. Utility of Stool PCR for the diagnosis of COVID-19: Comparison of two commercial platforms. J Clin Microbiol 2020; 58(9): e01369-20.
47. Goldfarb DM, Tilley P, Al-Rawahi GN, Srigley JA, Ford G, Pedersen H, et al. Self-Collected saline gargle samples as an Alternative to Health care Worker-Collected Nasopharyngeal swabs for COVID-19 diagnosis in Outpatients. J Clin Microbiol 2021; 59(4): e02427-20.
48. Fan J, Yu F, Wang X, Zou Q, Lou B, Xie G, et al. Hock-a-loogie saliva as a diagnostic specimen for SARS-CoV-2 by a PCR-based assay: A diagnostic validity study. Clin Chim Acta 2020; 511: 177-180.
49. Nawattanapaiboon K, Pasomsub E, Prombun P, Wongbunmak A, Jenjitwanich A, Mahasupachai P, et al. Colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) as a visual diagnostic platform for the detection of the emerging coronavirus SARS-CoV-2. Analyst 2021; 146: 471-477.
50. Lim B, Ratcliff J, Nawrot DA, Yu Y, Sanghani HR, Hsu CC, et al. Clinical validation of optimised RT-LAMP for the diagnosis of SARS-CoV-2 infection. Sci Rep 2021; 11: 16193.
51. Roumani F, Azinheiro S, Sousa H, Sousa A, Timóteo M, Varandas T, et al. Optimization and clinical evaluation of a Multi-Target Loop-Mediated isothermal amplification assay for the detection of SARS-CoV-2 in Nasopharyngeal samples. Viruses 2021; 13: 940.
52. Huang WE, Lim B, Hsu CC, Xiong D, Wu W, Yu Y, et al. RT-LAMP for rapid diagnosis of coronavirus SARS-CoV-2. Microb Biotechnol 2020; 13: 950-961.
53. Böger B, Fachi MM, Vilhena RO, Cobre AF, Tonin FS, Pontarolo R. Systematic review with meta-analysis of the accuracy of diagnostic tests for COVID-19. Am J Infect Control 2021; 49: 21-29.
54. Kim M, Kweon S, Lee J, Baek S, Jeon B, Yoo H, et al. Weekly report on the COVID-19 situation in the Republic of Korea (As of March 28, 2020). Public Health Weekly Report 2020; 13: 792-806.
55. Xie JW, He Y, Zheng YW, Wang M, Lin Y, Lin L-R. Diagnostic accuracy of rapid antigen test for SARS-CoV-2: A systematic review and meta-analysis of 166,943 suspected COVID-19 patients. Microbiol Res 2022; 265: 127185.
56. Vilca-Alosilla JJ, Candia-Puma MA, Coronel-Monje K, Goyzueta-Mamani LD, Galdino AS, Machado-de-Ávila RA, et al. A systematic review and meta-analysis comparing the diagnostic accuracy tests of COVID-19. Diagnostics (Basel) 2023; 13: 1549.
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Issue | Vol 17 No 5 (2025) | |
Section | Review Article(s) | |
DOI | https://doi.org/10.18502/ijm.v17i5.19875 | |
Keywords | ||
SARS-CoV-2 Diagnostic tests Sensitivity Specificity Meta-analysis |
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