Clinical Prediction Rule for Stratifying Risk of Pulmonary Multidrug-Resistant Tuberculosis
Clinical Prediction Rule for Stratifying Risk of Pulmonary Multidrug-Resistant Tuberculosis
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DOI：
10.1371/journal.pone.0012082
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发表时间：
2010-08-11
期刊：
影响因子：
3.7
通讯作者：
Estrada, Carlos
中科院分区：
文献类型：
--
作者：
Martinez, Dalila;Heudebert, Gustavo;Estrada, Carlos
背景：耐多药结核病(MDR-TB)，至少对异烟肼和利福平耐药，是一个世界性的问题。目的：制定一项临床预测规则，对肺结核患者中的MDR-TB风险进行分层。方法：对37个卫生中心(秘鲁)前瞻性招募的成年患者进行规则的推导和内部验证，无论是a)抗酸杆菌涂片阳性，还是b)在前12个月内治疗失败或复发。结果：在964名患者中，82人患有MDR-TB(患病率，8.5%)。变量包括家庭内接触耐多药结核病、既往结核病、空洞放射学类型和异常肺部检查。受试者工作曲线下面积(AUROC)为0.76。选择1分或1分以上的临界值，敏感度为72.6%，特异度为62.8%，似然比为1.95，似然比为0.44。同样，选择2分或更高的分界值，敏感性为60.8%，特异性为87.5%，LR阳性为4.85，LR阴性为0.45。最终，选择3分或更高的分界值，敏感性为45.1%，特异性为95.3%，LR阳性为9.56，LR阴性为0.58。结论：一个简单的临床预测规则可以对耐多药结核病的风险进行分层。如果进一步验证，该规则可用于资源有限地区的管理决策。
Background: Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem.Objective: To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis.Methods: Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Peru), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months.Results: Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58.Conclusion: A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas.