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Score for pulmonary tuberculosis in patients with clinical presumption of tuberculosis in a low-prevalence area
DESIGN: A 1:1 case-control study was conducted in consecutive immunocompetent patients with presumed PTB hospitalised between 2009 and 2012 in Paris, France. Cases were defined as individuals with culture-confirmed PTB, regardless of smear result. Those with presumed PTB and three smear- and culture-negative samples were selected as controls. A score was derived using conditional logistic regression. Internal validity of the score was assessed using the bootstrap method.
RESULTS: A total of 354 patients were included in the analysis (177 cases, 177 controls). Among the 177 cases, 74 (42%) were smear-negative but culture-positive. Factors independently associated with PTB were age <50 years (adjusted OR [aOR] 4.7, 95%CI 1.8–12), diabetes (aOR 3.2, 95%CI 1.1–9.8), absence of cough with or without sputum (aOR 3.7, 95%CI 1.7–8.3), fever >15 days (aOR 3.5, 95%CI 1.3–9.5), apical infiltration without cavity (aOR 3.4, 95%CI 1.4–8.5) and cavitation or miliary pattern (aOR 19.7, 95%CI 7.6–51.1). Score C-index was 0.84 (95%CI 0.79–0.88). Calibration for the overall population (P = 0.770) and in smear-negative patients (P = 0.980) was appropriate. A score of 3.3 had 90% sensitivity, 50% specificity and 79% (IQR 28–95) median probability of PTB.
CONCLUSIONS: This score could be used to build an algorithm to determine the need for respiratory isolation and/or NAAT use in PTB disease.
Keywords: PTB; case-control study; diagnosis; immunocompetent; nucleic-acid amplification technique
Document Type: Research Article
Affiliations: 1: Assistance Publique-Hôpitaux de Paris (APHP), Département Epidémiologie et Recherche Clinique, Hôpital Bichat-Claude Bernard, Paris, France; Centre d'Investigation Clinique 1425-EC, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; APHP, Service de Maladies Infectieuses et Tropicales, Hôpital Saint Louis, Paris, France 2: APHP, Service de Maladies Infectieuses et Tropicales, Paris, France 3: Service de Bactériologie, Paris, France 4: Service d'Accueil des Urgences, Paris, France 5: Service de Pneumologie, Paris, France 6: Assistance Publique-Hôpitaux de Paris (APHP), Département Epidémiologie et Recherche Clinique, Hôpital Bichat-Claude Bernard, Paris, France; Centre d'Investigation Clinique 1425-EC, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables, Paris, France 7: Service de Virologie, Hôpital Bichat-Claude Bernard, Paris, France 8: Assistance Publique-Hôpitaux de Paris (APHP), Département Epidémiologie et Recherche Clinique, Hôpital Bichat-Claude Bernard, Paris, France; Centre d'Investigation Clinique 1425-EC, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris 9: APHP, Service de Maladies Infectieuses et Tropicales, France 10: Assistance Publique-Hôpitaux de Paris (APHP), Département Epidémiologie et Recherche Clinique, Hôpital Bichat-Claude Bernard, Paris, France; Centre d'Investigation Clinique 1425-EC, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables, Paris , Université Paris Diderot, Sorbonne Paris Cité, Paris, France
Publication date: 01 December 2017
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