Predicting tuberculosis relapse in patients treated with the standard 6-month regimen: an individual patient data meta-analysis
Predicting tuberculosis relapse in patients treated with the standard 6-month regimen: an individual patient data meta-analysis
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DOI：
10.1136/thoraxjnl-2017-211120
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发表时间：
2019-03-01
期刊：
影响因子：
10
通讯作者：
Johnston, James C.
中科院分区：
文献类型：
--
作者：
Romanowski, Kamila;Balshaw, Robert F.;Johnston, James C.
背景复发继续给全世界的结核病患者和结核病规划带来重大负担。我们的目的是确定临床和微生物学因素与复发的患者治疗与WHO标准的6个月方案，然后评估每个因素的准确性，在预测的结果realization.Methods进行系统回顾，以确定随机对照试验报告的治疗结果对患者接受标准方案。联系并邀请作者分享患者水平数据（IPD）。一个一步IPD荟萃分析，使用随机截距logistic回归模型和接收器操作特征曲线，进行评估的预测性能的变量interest.Results个体患者的数据从3的12个确定的研究。在1189例完成治疗的确诊肺结核患者中，67例（5.6%）复发。在多预测因素分析中，基线空洞性疾病伴2个月涂片阳性与复发几率增加相关（OR 2.3（95%CI 1.3 - 4.2）），复发风险为10%。当比较每个多预测因子模型的曲线下面积时，低风险和高风险患者之间的区分是适度的，并且与考虑年龄，性别和HIV状态的参考模型相似。我们的研究结果表明，空洞性疾病和2-一个月的阳性涂片状态可能是目前最好的标记，用于识别复发风险增加的个人，特别是在资源有限的情况下。需要进一步的研究来评估这种组合因素是否可以用于指示临床实践中的不同治疗要求。
Background Relapse continues to place significant burden on patients and tuberculosis (TB) programmes worldwide. We aimed to determine clinical and microbiological factors associated with relapse in patients treated with the WHO standard 6-month regimen and then evaluate the accuracy of each factor at predicting an outcome of relapse.Methods A systematic review was performed to identify randomised controlled trials reporting treatment outcomes on patients receiving the standard regimen. Authors were contacted and invited to share patient-level data (IPD). A one-step IPD meta-analysis, using random intercept logistic regression models and receiver operating characteristic curves, was performed to evaluate the predictive performance of variables of interest.Results Individual patient data were obtained from 3 of the 12 identified studies. Of the 1189 patients with confirmed pulmonary TB who completed therapy, 67 (5.6%) relapsed. In multipredictor analysis, the presence of baseline cavitary disease with positive smear at 2 months was associated with an increased odds of relapse (OR 2.3(95% CI 1.3 to 4.2)) and a relapse risk of 10%. When area under the curve for each multipredictor model was compared, discrimination between low-risk and higher-risk patients was modest and similar to that of the reference model which accounted for age, sex and HIV status.Conclusion Despite its poor predictive value, our results indicate that the combined presence of cavitary disease and 2-month positive smear status may be the best currently available marker for identifying individuals at an increased risk of relapse, particularly in resource-limited setting. Further investigation is required to assess whether this combined factor can be used to indicate different treatment requirements in clinical practice.