Validation of a model for predicting smear-positive active pulmonary tuberculosis in patients with initial acid-fast bacilli smear-negative sputum

doi:10.1007/s00330-017-4959-9

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Title:	Validation of a model for predicting smear-positive active pulmonary tuberculosis in patients with initial acid-fast bacilli smear-negative sputum
Authors:	Yeh, Jun-Jun
Contributors:	Chia Yi Christian Hosp, Ditmanson Med Fdn, Dept Chest Med Chia Nan Univ Pharm & Sci Meiho Univ Pingtung Christian Hosp Heng Chun Christian Hosp
Keywords:	Acid-fast bacilli High-resolution computed tomography Sensitivity Specificity Pulmonary tuberculosis
Date:	2018-01
Issue Date:	2019-11-15 15:48:04 (UTC+8)
Publisher:	SPRINGER
Abstract:	The objective of this study was to develop a predictive model for final smear-positive (SP) active pulmonary tuberculosis (aPTB) in patients with initial negative acid fast bacilli (AFB) sputum smears (iSN-SP-aPTB) based on high-resolution computed tomography (HRCT). Eighty (126, 21) patients of iSN-SP-aPTB and 402 (459, 876) patients of non-initial positive acid fast bacilli (non-iSP) pulmonary disease without iSN-SP-aPTB were included in a derivation (validation, prospective) cohort. HRCT characteristics were analysed, and multivariable regression and receiver operating characteristic (ROC) curve analysis was performed to develop a score predictive of iSN-SP-aPTB. The derivation cohort showed clusters of nodules/mass of the right upper lobe or left upper lobe were independent predictors of iSN-SP-aPTB, while bronchiectasis in the right middle lobe or left lingual lobe were negatively associated with iSN-SP-aPTB. A predictive score for iSN-SP-aPTB based on these findings was tested in the validation and prospective cohorts. With an ideal cut-off score = 1, the sensitivity, specificity, positive predictive value, and negative predictive value of the prediction model were 87.5% (90%, 90.5%), 99% (97.1%, 98.4%), 94.6% (81.3%, 57.5%), and 97.6% (97%, 99.8%) in the derivation (validation, prospective) cohorts, respectively. The model may help identify iSN-SP-aPTB among patients with non-iSP pulmonary diseases. aEuro cent Smear-positive active pulmonary tuberculosis that is initial smear-negative (iSN-SP-aPTB) is infectious. aEuro cent High-resolution computed tomography can identify iSN-SP-aPTB among non-iSP pulmonary diseases. aEuro cent Clusters nodules/mass in right/left upper lobe are positively associated with iSN-SP-aPTB. aEuro cent Bronchiectasis in right middle/left lingual lobe is negatively associated with iSN-SP-aPTB. aEuro cent The model may have high post-test probability in identifying iSN-SP-aPTB.
???metadata.dc.relation.uri???:	http://dx.doi.org/10.1007/s00330-017-4959-9
Relation:	Molecular Neurobiology, v.28, n.1, pp.243-256
Appears in Collections:	[Dept. of Childhood Education and Nursery] Periodical Articles

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