Clinical utility of WHO-recommended screening tools and development and validation of novel clinical prediction models for pulmonary tuberculosis screening among outpatients living with HIV: an individual participant data meta-analysis.
Clinical utility of WHO-recommended screening tools and development and validation of novel clinical prediction models for pulmonary tuberculosis screening among outpatients living with HIV: an individual participant data meta-analysis.
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DOI：
10.1183/16000617.0021-2023
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发表时间：
2023-06-30
影响因子：
7.5
通讯作者：
Barr, David A.
中科院分区：
文献类型：
--
作者：
Dhana, Ashar;Gupta, Rishi K.;Hamada, Yohhei;Kengne, Andre P.;Kerkhoff, Andrew D.;Yoon, Christina;Cattamanchi, Adithya;Reeve, Byron W. P.;Theron, Grant;Ndlangalavu, Gcobisa;Wood, Robin;Drain, Paul K.;Calderwood, Claire J.;Noursadeghi, Mahdad;Boyles, Tom;Meintjes, Graeme;Maartens, Gary;Barr, David A.
世界卫生组织（世卫组织）建议门诊艾滋病毒感染者（PLHIV）接受世卫组织四症状筛查（W 4SS）或C反应蛋白（CRP）（5 mg·L−1临界值）的结核病筛查，如果筛查阳性，则进行确证性检测。 我们进行了一项个体参与者数据荟萃分析，以确定WHO推荐的筛查工具和两种新开发的临床预测模型（CPM）的性能。在系统回顾后，我们确定了招募成人门诊PLHIV患者的研究，无论其是否有结核病体征和症状或W 4SS阳性，评估CRP并收集痰液进行培养。我们使用逻辑回归来开发扩展的CPM（包括CRP和其他预测因子）和仅CRP的CPM。我们使用内部-外部交叉验证来评估性能。我们汇总了来自8个队列（n=4315名参与者）的数据。扩展CPM具有极好的区分度（C-统计量0.81）;仅CRP CPM具有类似的区分度。世卫组织推荐的工具的C统计量较低。与世卫组织推荐的工具相比，两种CPM的净效益相等或更高。与两种CPM相比，CRP（5 mg·L−1临界值）在临床有用的阈值概率范围内具有相同的净获益，而W 4SS的净获益较低。 W 4SS将捕获91%的结核病病例，并要求对78%的参与者进行确认性检测。CRP（5 mg·L-1临界值）、扩展CPM（4.2%阈值）和仅CRP CPM（3.6%阈值）将捕获相似的病例百分比，但分别减少24%、27%和36%所需的确证性试验。 CRP为门诊艾滋病毒感染者的结核病筛查设定了标准。在5 mg·L−1临界值或CPM中使用CRP的选择取决于可用资源。 本研究中，5 mg临界https://bit.ly/3yShJ3m的C-反应蛋白和两个新开发的临床预测模型显示了在门诊PLHIV患者中进行结核病筛查的临床实用性，而世卫组织推荐的四症状筛查显示了次优临床实用性。
The World Health Organization (WHO) recommends that outpatient people living with HIV (PLHIV) undergo tuberculosis screening with the WHO four-symptom screen (W4SS) or C-reactive protein (CRP) (5 mg·L−1 cut-off) followed by confirmatory testing if screen positive. We conducted an individual participant data meta-analysis to determine the performance of WHO-recommended screening tools and two newly developed clinical prediction models (CPMs). Following a systematic review, we identified studies that recruited adult outpatient PLHIV irrespective of tuberculosis signs and symptoms or with a positive W4SS, evaluated CRP and collected sputum for culture. We used logistic regression to develop an extended CPM (which included CRP and other predictors) and a CRP-only CPM. We used internal–external cross-validation to evaluate performance. We pooled data from eight cohorts (n=4315 participants). The extended CPM had excellent discrimination (C-statistic 0.81); the CRP-only CPM had similar discrimination. The C-statistics for WHO-recommended tools were lower. Both CPMs had equivalent or higher net benefit compared with the WHO-recommended tools. Compared with both CPMs, CRP (5 mg·L−1 cut-off) had equivalent net benefit across a clinically useful range of threshold probabilities, while the W4SS had a lower net benefit. The W4SS would capture 91% of tuberculosis cases and require confirmatory testing for 78% of participants. CRP (5 mg·L−1 cut-off), the extended CPM (4.2% threshold) and the CRP-only CPM (3.6% threshold) would capture similar percentages of cases but reduce confirmatory tests required by 24, 27 and 36%, respectively. CRP sets the standard for tuberculosis screening among outpatient PLHIV. The choice between using CRP at 5 mg·L−1 cut-off or in a CPM depends on available resources. C-reactive protein at a 5 mg cut-off and two newly developed clinical prediction models from this study show clinical utility for TB screening among outpatient PLHIV, while the WHO-recommended four-symptom screen showed suboptimal clinical utility https://bit.ly/3yShJ3m
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影响因子：
4.2
作者：
Boyles, Tom H.;Nduna, Matilda;Maartens, Gary
通讯作者：
Maartens, Gary
影响因子：
15.8
作者：
Baik Y;Rickman HM;Hanrahan CF;Mmolawa L;Kitonsa PJ;Sewelana T;Nalutaaya A;Kendall EA;Lebina L;Martinson N;Katamba A;Dowdy DW
通讯作者：
Dowdy DW
DOI：
10.1016/s1473-3099(21)00387-x
发表时间：
2022-04
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Dhana A;Hamada Y;Kengne AP;Kerkhoff AD;Rangaka MX;Kredo T;Baddeley A;Miller C;Singh S;Hanifa Y;Grant AD;Fielding K;Affolabi D;Merle CS;Wachinou AP;Yoon C;Cattamanchi A;Hoffmann CJ;Martinson N;Mbu ET;Sander MS;Balcha TT;Skogmar S;Reeve BWP;Theron G;Ndlangalavu G;Modi S;Cavanaugh J;Swindells S;Chaisson RE;Ahmad Khan F;Howard AA;Wood R;Thit SS;Kyi MM;Hanson J;Drain PK;Shapiro AE;Kufa T;Churchyard G;Nguyen DT;Graviss EA;Bjerrum S;Johansen IS;Gersh JK;Horne DJ;LaCourse SM;Al-Darraji HAA;Kamarulzaman A;Kempker RR;Tukvadze N;Barr DA;Meintjes G;Maartens G
通讯作者：
Maartens G
影响因子：
11.8
作者：
Rangaka, Molebogeng X.;Wilkinson, Robert J.;Maartens, Gary
通讯作者：
Maartens, Gary
影响因子：
15.8
作者：
Getahun H;Kittikraisak W;Heilig CM;Corbett EL;Ayles H;Cain KP;Grant AD;Churchyard GJ;Kimerling M;Shah S;Lawn SD;Wood R;Maartens G;Granich R;Date AA;Varma JK
通讯作者：
Varma JK