The value of end-of-treatment chest radiograph in predicting pulmonary tuberculosis relapse
Abstract:SETTING: Patients with cavitary pulmonary tuberculosis (TB) on baseline chest radiograph (CXR) who remain culture-positive after 8 weeks of treatment are at high risk of relapse. The role of end-of-treatment (EOT) CXR in predicting relapse is unclear.
OBJECTIVE: To determine whether EOT CXR independently predicts TB relapse.
DESIGN: We conducted a secondary analysis of a randomized trial of intermittent treatment using rifapentine in the continuation phase of TB treatment among 1004 human immunodeficiency virus seronegative adults with culture-proven pulmonary TB.
RESULTS: Relapse occurred in 17.3% of subjects with persistent cavity on EOT CXR, in 7.6% of subjects with a cavity that resolved by EOT, and 2.5% (P = 0.002 for trend) of subjects who never had a cavity. In multivariable analysis, patients with persistent cavity on EOT CXR were significantly more likely to relapse than patients with no cavity on baseline or 2-month CXR (hazard ratio [HR] 4.22, 95%CI 2.00–8.91), and were more likely to relapse than subjects whose early cavity had resolved by EOT CXR (HR 1.92, 95%CI 1.09–3.39).
CONCLUSION: A persistent cavity after 6 months of TB treatment was independently associated with disease relapse after controlling for other variables. EOT CXR may help predict those likely to relapse.
Document Type: Regular Paper
Affiliations: 1: Division of Infectious Diseases & International Health, Duke University Medical Center and the Durham Veterans' Affairs Medical Center, Durham, North Carolina, USA 2: Division of Chest Radiography, Duke University Medical Center, Durham, North Carolina, USA 3: Montreal Chest Institute, McGill University, Montreal, Quebec, Canada 4: Division of Pulmonary Allergy & Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA 5: Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 6: Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, USA
Publication date: September 1, 2008
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