Development of a Clinical Prediction Score Including Monocyte-to-Lymphocyte Ratio to Inform Tuberculosis Treatment Among Children With HIV: A Multicountry Study.
Development of a Clinical Prediction Score Including Monocyte-to-Lymphocyte Ratio to Inform Tuberculosis Treatment Among Children With HIV: A Multicountry Study.
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DOI：
10.1093/ofid/ofac548
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发表时间：
2022-11
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
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临床儿科结核病（TB）诊断可能导致过度诊断，特别是在患有人类免疫缺陷病毒（CHIV）的儿童中。我们评估了单核细胞-淋巴细胞比率（MLR）作为诊断生物标志物的性能，并构建了临床预测评分，以提高在微生物学检测有限的情况下对CHIV进行结核病诊断的特异性。我们汇集了来自越南、喀麦隆和南非≤13岁儿童队列的数据，以验证MLR≥0.378的使用，MLR≥0.378曾被发现作为CHIV的结核病诊断标志物。使用多变量逻辑回归，我们创建了一个内部验证的预测评分，用于诊断chv中的结核病。合并队列有601名儿童（年龄中位数为1.9岁[四分位数间距，0.9-5.3岁]）；300名（50%）儿童为男性，283名（47%）儿童感染艾滋病毒。在验证队列中，升高的MLR≥0.378对CHIV的敏感性为36%(95%可信区间[CI]， 23%-51%)，特异性为79% （95% CI, 71%-86%）。MLR≥0.28、年龄≥4岁、结核菌素皮肤试验≥5 mm、结核病接触史、发热bbb2周和提示结核病的胸片提示结核的模型预测CHIV活动性结核，受者工作特征曲线下面积为0.85。预测评分≥5分对确诊结核的敏感性为94%，特异性为48%，对确诊和未确诊结核组的敏感性为82%，特异性为48%。我们的评分与包括微生物检测在内的算法具有相当的敏感性和特异性，应该使临床医生能够在无法进行微生物检测时迅速启动艾滋病毒感染者的结核病治疗。
Clinical pediatric tuberculosis (TB) diagnosis may lead to overdiagnosis particularly among children with human immunodeficiency virus (CHIV). We assessed the performance of monocyte-lymphocyte ratio (MLR) as a diagnostic biomarker and constructed a clinical prediction score to improve specificity of TB diagnosis in CHIV with limited access to microbiologic testing. We pooled data from cohorts of children aged ≤13 years from Vietnam, Cameroon, and South Africa to validate the use of MLR ≥0.378, previously found as a TB diagnostic marker among CHIV. Using multivariable logistic regression, we created an internally validated prediction score for diagnosis of TB disease in CHIV. The combined cohort had 601 children (median age, 1.9 [interquartile range, 0.9–5.3] years); 300 (50%) children were male, and 283 (47%) had HIV. Elevated MLR ≥0.378 had sensitivity of 36% (95% confidence interval [CI], 23%–51%) and specificity of 79% (95% CI, 71%–86%) among CHIV in the validation cohort. A model using MLR ≥0.28, age ≥4 years, tuberculin skin testing ≥5 mm, TB contact history, fever >2 weeks, and chest radiograph suggestive of TB predicted active TB disease in CHIV with an area under the receiver operating characteristic curve of 0.85. A prediction score of ≥5 points had a sensitivity of 94% and specificity of 48% to identify confirmed TB, and a sensitivity of 82% and specificity of 48% to identify confirmed and unconfirmed TB groups combined. Our score has comparable sensitivity and specificity to algorithms including microbiological testing and should enable clinicians to rapidly initiate TB treatment among CHIV when microbiological testing is unavailable.
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DOI：
10.1093/infdis/jit494
发表时间：
2014-02-15
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Naranbhai V;Hill AV;Abdool Karim SS;Naidoo K;Abdool Karim Q;Warimwe GM;McShane H;Fletcher H
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DOI：
10.1097/qai.0000000000001893
发表时间：
2019-02-01
期刊：
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影响因子：
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影响因子：
6.4
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Ayaya, Samuel O.
DOI：
10.5588/ijtld.21.0300
发表时间：
2021-11-01
影响因子：
4
作者：
Gatechompol, S.;Sophonphan, J.;Cobelens, F.
通讯作者：
Cobelens, F.