Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
PLoS One. 2010 Aug 11;5(8):e12082. doi: 10.1371/journal.pone.0012082.
Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem.
To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis.
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.
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.
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.
耐多药结核病（MDR-TB），即至少对异烟肼和利福平耐药，是一个全球性问题。
为耐多药结核病患者建立一种临床预测规则，以分层风险。
从 37 个医疗中心（秘鲁）前瞻性招募的成年患者中得出并内部验证该规则，纳入标准为：a）痰抗酸杆菌涂片阳性，或 b）治疗失败或在最初 12 个月内复发。
在 964 名患者中，有 82 名患有 MDR-TB（患病率为 8.5%）。纳入的变量包括家庭内 MDR-TB 接触史、既往结核病、空洞性放射学模式和异常肺部检查。受试者工作特征曲线下面积（AUROC）为 0.76。选择得分≥1 作为截断值，灵敏度为 72.6%，特异度为 62.8%，阳性似然比（LR+）为 1.95，阴性似然比（LR-）为 0.44。同样，选择得分≥2 作为截断值，灵敏度为 60.8%，特异度为 87.5%，LR+为 4.85，LR-为 0.45。最后，选择得分≥3 作为截断值，灵敏度为 45.1%，特异度为 95.3%，LR+为 9.56，LR-为 0.58。
一种简单的临床预测规则可在发病时对 MDR-TB 进行分层。如果进一步验证，该规则可用于资源有限地区的管理决策。
