Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Int J Tuberc Lung Dis. 2013 Dec;17(12):1626-31. doi: 10.5588/ijtld.13.0183.
A suburban teaching hospital in a tuberculosis (TB) prevalent area.
To evaluate the proportion of pulmonary TB among patients hospitalised with suspected community-acquired pneumonia (CAP), and to develop a diagnostic index for identifying TB among these patients.
TB cases confirmed using 1) sputum culture, or 2) both sputum acid-fast bacilli smear and polymerase chain reaction for Mycobacterium tuberculosis, were compared with non-tuberculous CAP by demographic, clinical, laboratory and radiographic information. Using multiple logistic regression analysis, risk factors for TB were identified. A diagnostic index was developed by summing up their simplified regression coefficients. Its performance was checked using c-statistic.
TB was the second leading cause of CAP (37/528, 7.0%). Risk factors were initial symptoms >7 days, serum albumin <3.5 g/dl, cavitary/nodular infiltrates and upper lobe involvement (1 point for each). The c-statistic of the index was 0.856 (95%CI 0.789-0.923), and for bootstrapping samples of 1000 repetitions it was 0.856 (95%CI 0.791-0.921). For scores ≥2, sensitivity and specificity were respectively 81.1% and 75.8%.
TB is one of the leading causes of CAP in TB-prevalent areas. Our diagnostic index may help clinicians identify TB immediately from CAP and initiate appropriate isolation and optimal treatment.
一个位于结核病高发地区的郊区教学医院。
评估疑似社区获得性肺炎（CAP）住院患者中肺结核（TB）的比例，并制定一种用于识别这些患者中 TB 的诊断指标。
使用 1）痰培养，或 2）痰抗酸杆菌涂片和结核分枝杆菌聚合酶链反应，对 TB 病例进行确认，并将其与非结核性 CAP 进行比较，比较内容包括人口统计学、临床、实验室和影像学信息。使用多因素逻辑回归分析确定 TB 的危险因素。通过总结它们的简化回归系数来开发诊断指标。使用 C 统计量检查其性能。
TB 是 CAP 的第二大常见病因（37/528，7.0%）。危险因素包括初始症状>7 天、血清白蛋白<3.5g/dl、空洞/结节性浸润和上叶受累（每项 1 分）。该指标的 C 统计量为 0.856（95%CI 0.789-0.923），在 1000 次重复的 Bootstrap 样本中，其 C 统计量为 0.856（95%CI 0.791-0.921）。对于得分≥2，敏感性和特异性分别为 81.1%和 75.8%。
TB 是结核病高发地区 CAP 的主要病因之一。我们的诊断指标可能有助于临床医生从 CAP 中立即识别 TB，并立即进行适当的隔离和最佳治疗。
