Predictors of Initial Smear-Negative Active Pulmonary Tuberculosis with Acute Early Stage Lung Injury by High-Resolution Computed Tomography and Clinical Manifestations: An Auxiliary Model in Critical Patients

doi:10.1038/s41598-019-40799-w

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Title:	Predictors of Initial Smear-Negative Active Pulmonary Tuberculosis with Acute Early Stage Lung Injury by High-Resolution Computed Tomography and Clinical Manifestations: An Auxiliary Model in Critical Patients
Authors:	Yeh, Jun-Jun(葉俊濬)
Contributors:	Ditmanson Med Fdn, Chia Yi Christian Hosp, Dept Pulm Med, Sect Thorac Imaging & Family Med Chia Nan Univ Pharm & Sci, China Med Univ Pingtung Christian Hosp Heng Chun Christian Hosp
Keywords:	RESPIRATORY-DISTRESS-SYNDROME CRITICAL CARE IMAGE QUALITY CT DIAGNOSIS CHEST PHYSICIAN VALIDATION FEATURES
Date:	2019-03
Issue Date:	2020-07-29 13:55:21 (UTC+8)
Publisher:	NATURE PUBLISHING GROUP
Abstract:	This study evaluated the diagnostic use of high-resolution computed tomography (HRCT), chest X-ray (CXR), and clinical manifestations (CM) to identify initial smear-negative (iSN) active pulmonary tuberculosis (aPTB) [iSN-aPTB] in patients with iSN-pulmonary diseases (PD) and acute lung injury (ALI). In the derivation cohort, the [iSN-PD] with ALI patients were divided into the [iSN-aPTB] (G1, n = 26) and [non-aPTB-PD] (G2, n= 233) groups. Lung morphology, number, and lobar (segmental) distribution were evaluated using CXR and HRCT. A multivariate analysis was performed to identify independent variables associated with G1, which were used to generate predictive score models for G1. The predictive model was validated in a separate population of patients (n = 372) with [iSN-PD] and (ALI). The validated model for [HRCT (CXR + Hypoalbuminemia)] had 93.5% (25.8%) sensitivity, 99.5% (89.4%) specificity, and a negative predictive value of 99.5% (93.0%). For [iSN-aPTB], the post-test probability in the derivation cohort (prevalence =10%), validation cohort (prevalence = 8.3%), and the given prevalence (prevalence = 1%) was 88.7%, 94.4%, and 41.5%, respectively. The HRCT model effectively identified the [iSN-aPTB] subjects among the [iSN-PD] with ALI, regardless of CM. The [non-aPTB-PD] were also correctly classified by the HRCT and [CXR + Hypoalbuminemia] models.
Relation:	Scientific Reports, v.9, 4527
Appears in Collections:	[Dept. of Childhood Education and Nursery] Periodical Articles

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