Higher incidence of indeterminate tb-interferon gamma release assay among hospitalized covid-19 patients: a systematic review

SESSION TITLE: Chest Infections Posters 4 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: IGRA-based tests, such as QuantiFERON TB gold (QFT), are often performed in COVID-19 patients before initiating immunosuppressive agents to screen for latent tuberculosis (TB). Our study aims to systematically explore the incidence of indeterminate IGRA tests in hospitalized COVID-19 population. METHODS: We conducted a comprehensive literature search in PubMed, MEDLINE, Embase, Cochrane, and additional databases to identify studies between January 2019 and September 2022. Our search included studies reporting the incidence of indeterminate TB - IGRA tests in hospitalized COVID-19 patients. Two independent reviewers screened each abstract and title on Covidence software to decide eligibility for inclusion. A full-text review was done following title and abstract screening to determine final eligibility. Due to limited studies presenting quantitative data, a meta-analysis could not be performed. RESULTS: Our literature search yielded 2099 studies, of which 782 were duplicates, and 1317 were identified for screening. After the abstract and title-based screening, 9 studies were found eligible for full-text review, and 7 studies contained quantitative data relevant to our study aims. The sample size of the studies varied from small (45 patients, Ward et al.) to large (504 patients, Cortes et al.). The rate of indeterminate QFT in COVID-19 cohorts ranged from 17.7% (Gutierrez et al.) to 64.58% (Ward et al.), which is significantly higher than baseline indeterminate result rates (2-10%). Although most studies did not show significant differences across these demographic characteristics, higher rate of indeterminate QFT results were reported in male patients (Cortes et al., Imineo et al., and Torre et al.), older age groups (Imineo et al.) and of Asian origin (Cortes et al.). While Cortes et al. reported a higher incidence of indeterminate results in Chronic Kidney Disease, Diabetes Mellitus, Solid Organ Transplant, Chronic Lung Disease, and breakthrough infection, Coppock et al.’s study did not show any such difference. A high inflammatory state was also reflected in the laboratory results of COVID-19 patients with indeterminate QFT results. A higher degree of Neutrophilia, Leukocytosis, neutrophil to lymphocyte(N/L) ratio, C- reactive protein (CRP), Lactate dehydrogenase (LDH), and D-dimer in the indeterminate QFT group compared to the determinate group were reported by Coppock et al., Cortes et al., Imineo et al. Solanich et. al. CONCLUSIONS: Existing literature suggests an elevated rate of indeterminate QFT results in hospitalized COVID-19 patients with a higher inflammatory response. CLINICAL IMPLICATIONS: Indeterminate QFT results can present therapeutic and diagnostic dilemmas when performed to screen for latent TB, such as in critically ill COVID-19 patients who are candidates for immunosuppressive therapies. DISCLOSURES: No relevant relationships by Mubashir Ayaz Ahmed No relevant relationships by Shivang Bhakta No relevant relationships by Tara Brigham No relevant relationships by Melissa Cortes No relevant relationships by Jennifer Cowart No relevant relationships by Shahin Isha No relevant relationships by Sadhana Jonna No relevant relationships by Pablo Moreno Franco No relevant relationships by Gunjan Mundhra No relevant relationships by Sai Abhishek Narra No relevant relationships by Smit Paghdar No relevant relationships by Archana Roy No relevant relationships by Devang Sanghavi No relevant relationships by PARTHKUMAR SATASHIA No relevant relationships by Carrie Schultz No relevant relationships by Jorge Sinclair De Frías No relevant relationships by Trisha Singh No relevant relationships by Ananya Vasudhar