Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, KY.
Eur Respir J. 2014 Jan;43(1):178-84. doi: 10.1183/09031936.00017813. Epub 2013 Jun 21.
The 22 risk factors suggested by the Centers for Disease Control and Prevention (CDC) to predict patients at risk for Mycobacterium tuberculosis have not been evaluated in hospitalised patients with community-acquired pneumonia (CAP). We evaluated which of the CDC risk factors best predict M. tuberculosis in these patients. To our knowledge, this is the first time a score has been developed assessing these risk factors. This was a secondary analysis of 6976 patients hospitalised with CAP enrolled in the Community-Acquired Pneumonia Organization International Cohort Study. Using Poisson regression, we selected the subset of risk factors that best predicted the presence of CAP due to M. tuberculosis. This subset was compared to the CDC risk factors using receiver operating characteristic (ROC) curve analysis. Five risk factors were found to best predict CAP due to M. tuberculosis: night sweats, haemoptysis, weight loss, M. tuberculosis exposure and upper lobe infiltrate. The area under the ROC curve for all CDC risk factors was 71% and 89% for the subset of five risk factors. The CDC-suggested risk factors are poor at predicting the presence of M. tuberculosis in hospitalised patients with CAP. With a subset of five risk factors identified in this study, we developed a new score, which will improve our capacity to isolate patients at risk of CAP due to M. tuberculosis at the time of hospitalisation.
美国疾病控制与预防中心（CDC）建议的 22 个预测结核病风险的因素尚未在社区获得性肺炎（CAP）住院患者中进行评估。我们评估了这些因素中哪些最能预测这些患者中的结核分枝杆菌。据我们所知，这是首次开发评估这些风险因素的评分。这是对社区获得性肺炎组织国际队列研究中纳入的 6976 例 CAP 住院患者进行的二次分析。我们使用泊松回归选择了最佳预测结核分枝杆菌引起的 CAP 的风险因素子集。使用受试者工作特征（ROC）曲线分析比较了这一子集与 CDC 风险因素。发现 5 个风险因素最能预测结核分枝杆菌引起的 CAP：盗汗、咯血、体重减轻、结核分枝杆菌暴露和上叶浸润。所有 CDC 风险因素的 ROC 曲线下面积为 71%，5 个风险因素子集为 89%。CDC 建议的风险因素在预测 CAP 住院患者中结核分枝杆菌的存在方面效果不佳。通过本研究确定的五个风险因素子集，我们开发了一个新的评分，这将提高我们在住院时隔离因结核分枝杆菌引起 CAP 的高危患者的能力。
