Clinical prediction rule for stratifying risk of pulmonary multidrug-resistant tuberculosis
| Autor: | Carlos Zamudio, Carlos Seas, Eduardo Gotuzzo, German Henostroza, Dalila Y. Martínez, Martin A. Rodriguez, Cesar Herrera, Robert M. Centor, Gustavo R. Heudebert, Carlos A. Estrada |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Tuberculosis Adolescent lcsh:Medicine Drug resistance Clinical prediction rule Risk Assessment Infectious Diseases/Bacterial Infections 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Evidence-Based Healthcare/Methods for Diagnostic and Therapeutic Studies lcsh:Science Tuberculosis Pulmonary History of tuberculosis Likelihood Functions 0303 health sciences Multidisciplinary Infectious Diseases/Antimicrobials and Drug Resistance 030306 microbiology business.industry Evidence-Based Healthcare/Clinical Decision-Making Multi-drug-resistant tuberculosis Isoniazid lcsh:R Reproducibility of Results Extensively drug-resistant tuberculosis Public Health and Epidemiology/Global Health medicine.disease Drug Resistance Multiple 3. Good health Multiple drug resistance Immunology Female lcsh:Q Disease Susceptibility business Evidence-Based Healthcare/Statistical Methodologies and Health Informatics Research Article medicine.drug |
| Zdroj: | PLoS ONE, Vol 5, Iss 8, p e12082 (2010) PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | Background Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem. Objective To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis. Methods Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months. Results Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58. Conclusion A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas. |
| Databáze: | OpenAIRE |
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