Diagnostic accuracy of dried blood spot samples for hepatitis B diagnosis: a systematic review and meta-analysis
In brief
Dried blood spot HBsAg test detects infection with about 94% sensitivity and 99% specificity
A meta-analysis of 44 studies found that dried blood spot sampling identifies hepatitis B surface antigen with roughly 94% sensitivity and 99% specificity, meeting criteria for community and primary-care screening. Anti-HBc and HBV DNA assays on dried spots were highly specific but less sensitive (around 84% and 87%). Wider adoption will require standardized collection and processing protocols.
- Journal
- Clinical chemistry and laboratory medicine (Q1)
- Published
- 26 August 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Songhe Wang, Xitong Yao, Xinyu Zhang, Jiaoqiang Chen, Pin Han, Wei Bai
- PMID
- 42643052
- DOI
- 10.1515/cclm-2026-1075
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 31 August 2026): High sensitivity DBS HBsAg assay
Abstract
INTRODUCTION: Hepatitis B virus (HBV) infection remains a major global public health problem. Dried blood spot (DBS) sampling is simple to collect, stable during transport, and easy to store, and may therefore provide an alternative sampling strategy for decentralized HBV testing. CONTENT: PubMed, Web of Science, MEDLINE, and Cochrane were searched for English-language studies published up to August 19, 2025. Eligible studies used DBS as the index test and venous blood, serum, or plasma testing as the reference standard. SUMMARY: Forty-four studies were included, yielding 61 datasets: 36 for HBsAg, 11 for anti-HBc, and 14 for HBV DNA. Based on the bivariate random-effects model, the pooled sensitivity and specificity of DBS-based HBsAg testing were 0.943 (95 % CI, 0.916-0.962) and 0.988 (95 % CI, 0.980-0.993), respectively, with a pooled DOR of 1,995.07 (95 % CI, 834.68-4,768.66). The pooled sensitivity and specificity were 0.836 (95 % CI, 0.737-0.902) and 0.973 (95 % CI, 0.937-0.989) for DBS-based anti-HBc testing, and 0.869 (95 % CI, 0.787-0.922) and 0.963 (95 % CI, 0.932-0.980) for DBS-based HBV DNA testing, respectively. Subgroup analyses showed that specificity remained relatively stable across most subgroups. Leave-one-out sensitivity analyses showed no directional change in the overall results after omitting individual studies. OUTLOOK: DBS-based HBsAg testing showed high diagnostic accuracy, supporting its use in community screening, primary care, and resource-limited settings. DBS-based anti-HBc and HBV DNA testing also showed high specificity, but their sensitivity was relatively lower. Further standardization of sample volume, filter paper type, elution procedures, storage conditions, and positivity thresholds is needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.