Incremental value of T-SPOT.TB for diagnosis of active pulmonary tuberculosis in children in a high-burden setting: a multivariable analysis.
Incremental value of T-SPOT.TB for diagnosis of active pulmonary tuberculosis in children in a high-burden setting: a multivariable analysis.
复制标题
DOI：
10.1136/thoraxjnl-2012-203086
复制
发表时间：
2013-09
期刊：
影响因子：
10
通讯作者：
Zar HJ
中科院分区：
文献类型：
--
作者：
Ling DI;Nicol MP;Pai M;Pienaar S;Dendukuri N;Zar HJ
干扰素γ释放试验（IGRA）越来越多地用于结核病（TB）感染，但其超出患者人口统计学、临床体征和活动性疾病常规检测的增量价值尚未在儿童中进行评估。在南非开普敦两家医院的491名痰检阴性儿童中评估了T-SPOT.TB的增量值。使用贝叶斯模型平均值来选择用于预测培养证实的TB的患者人口统计学和临床体征的最佳集合。T-SPOT.TB在患者特征和常规测试之上的附加值是使用统计数据测量的，例如受试者工作特征曲线下面积（AUC）、净重新分类改善（NRI）和综合辨别改善（IDI）。咳嗽超过2周、发热超过2周、夜间出汗、不适、家庭接触史和HIV状态是培养确诊的结核病的最重要预测因素。 当将二元T-SPOT.TB结果与临床预测因子、胸部X线摄影和结核菌素皮肤试验一起添加到基线模型中时，没有增加价值。AUC差异为3%（95% CI 0%-7%）。使用<10%，10-30%和> 30%的风险临界值，NRI为7%（95% CI-8%至31%），但CI包括零值。IDI为3%（95% CI 0%-11%），意味着所有可能临界值的平均预测概率略微提高了3%。在高负担环境中，T-SPOT.TB除了临床数据和常规检测之外，对痰检阴性儿童的结核病诊断没有附加价值。
Interferon γ release assays (IGRAs) are increasingly used for tuberculosis (TB) infection, but their incremental value beyond patient demographics, clinical signs and conventional tests for active disease has not been evaluated in children. The incremental value of T-SPOT.TB was assessed in 491 smear-negative children from two hospitals in Cape Town, South Africa. Bayesian model averaging was used to select the optimal set of patient demographics and clinical signs for predicting culture-confirmed TB. The added value of T-SPOT.TB over and above patient characteristics and conventional tests was measured using statistics such as the difference in the area under the receiver operating characteristic curve (AUC), the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI). Cough longer than 2 weeks, fever longer than 2 weeks, night sweats, malaise, history of household contact and HIV status were the most important predictors of culture-confirmed TB. Binary T-SPOT.TB results did not have incremental value when added to the baseline model with clinical predictors, chest radiography and the tuberculin skin test. The AUC difference was 3% (95% CI 0% to 7%). Using risk cut-offs of <10%, 10–30% and >30%, the NRI was 7% (95% CI −8% to 31%) but the CI included the null value. The IDI was 3% (95% CI 0% to 11%), meaning that the average predicted probability across all possible cut-offs improved marginally by 3%. In a high-burden setting, the T-SPOT.TB did not have added value beyond clinical data and conventional tests for diagnosis of TB disease in smear-negative children.