The diagnostic accuracy of saliva testing for SARS-CoV-2: A systematic review and meta-analysis
Corresponding Author
Momen A. Atieh
Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
Correspondence
Momen A. Atieh, Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates; Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Writing - original draft, Writing - review & editing
Search for more papers by this authorMarina Guirguis
Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
Contribution: Data curation, Methodology, Writing - original draft, Writing - review & editing
Search for more papers by this authorNabeel H. M. Alsabeeha
Prosthetic Section, Ras Al-Khaimah Dental Center, Ministry of Health and Prevention, Dubai, United Arab Emirates
Contribution: Formal analysis, Investigation, Methodology, Writing - original draft, Writing - review & editing
Search for more papers by this authorRichard D. Cannon
Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
Contribution: Investigation, Resources, Software, Writing - original draft, Writing - review & editing
Search for more papers by this authorCorresponding Author
Momen A. Atieh
Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
Correspondence
Momen A. Atieh, Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates; Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Writing - original draft, Writing - review & editing
Search for more papers by this authorMarina Guirguis
Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
Contribution: Data curation, Methodology, Writing - original draft, Writing - review & editing
Search for more papers by this authorNabeel H. M. Alsabeeha
Prosthetic Section, Ras Al-Khaimah Dental Center, Ministry of Health and Prevention, Dubai, United Arab Emirates
Contribution: Formal analysis, Investigation, Methodology, Writing - original draft, Writing - review & editing
Search for more papers by this authorRichard D. Cannon
Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
Contribution: Investigation, Resources, Software, Writing - original draft, Writing - review & editing
Search for more papers by this authorAbstract
Introduction
Early detection of coronavirus disease 2019 (COVID-19) is paramount for controlling the progression and spread of the disease. Currently, nasopharyngeal swabbing (NPS) is the standard method for collecting specimens. Saliva was recently proposed as an easy and safe option with many authorities adopting the methodology despite the limited evidence of efficacy.
Objectives
The aim of this review was to systematically evaluate the current literature on the use of saliva test for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and carry out a meta-analysis to determine its diagnostic accuracy.
Materials and methods
Prospective studies were searched for in electronic databases, complemented by hand-searching relevant journals. The risk of bias and applicability were assessed using the revised Quality Assessment of Studies of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analyses and meta-regression modeling were performed to calculate the diagnostic accuracy and examine sources of heterogeneity.
Results
A total of 16 studies were included with 2928 paired samples. The overall meta-analysis showed a high sensitivity and specificity for saliva test at 0.88 (95% CI 0.82–0.92) and 0.92 (95% CI 0.75–0.98), respectively. The diagnostic odds ratio was calculated at 87 (95% CI 19–395) and area under the curve was calculated as 0.92 (95% CI 0.90–0.94) suggesting very good performance of the saliva tests in detecting SARS-CoV-2.
Conclusion
Saliva testing has a very good discriminative and diagnostic ability to detect of SARS-CoV-2. Additional large and well-designed prospective studies are needed to further validate the diagnostic accuracy and determine a safe sample collection method prior to its recommendation for mass application.
Clinical relevance
Saliva demonstrated high sensitivity and specificity. The use of saliva will allow for self-collection of specimens and specimen collection in outpatient and community clinics.
CONFLICT OF INTEREST
Momen Atieh declares that he has no conflict of interest. Marina Guirguis declares that she has no conflict of interest. Nabeel Alsabeeha declares that he has no conflict of interest. Richard Cannon declares that he has no conflict of interest.
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