Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
Sci Rep. 2019 Apr 16;9(1):6143. doi: 10.1038/s41598-019-42372-x.
A prediction model of prevalent pulmonary tuberculosis (TB) in HIV negative/unknown individuals was developed to assist systematic screening. Data from a large TB screening trial were used. A multivariable logistic regression model was developed in the South African (SA) training dataset, using TB symptoms and risk factors as predictors. The model was converted into a scoring system for risk stratification and was evaluated in separate SA and Zambian validation datasets. The number of TB cases were 355, 176, and 107 in the SA training, SA validation, and Zambian validation datasets respectively. The area under curve (AUC) of the scoring system was 0·68 (95% CI 0·64-0·72) in the SA validation set, compared to prolonged cough (0·58, 95% CI 0·54-0·62) and any TB symptoms (0·6, 95% CI 0·56-0·64). In the Zambian dataset the AUC of the scoring system was 0·66 (95% CI 0·60-0·72). In the cost-effectiveness analysis, the scoring system dominated the conventional strategies. The cost per TB case detected ranged from 429 to 1,848 USD in the SA validation set and from 171 to 10,518 USD in the Zambian dataset. The scoring system may help targeted TB case finding under budget constraints.
开发了一种用于辅助系统筛查的 HIV 阴性/未知个体中流行肺结核（TB）的预测模型。使用了一项大型 TB 筛查试验的数据。在南非（SA）培训数据集内使用 TB 症状和危险因素作为预测因素，建立了多变量逻辑回归模型。该模型被转换为风险分层评分系统，并在单独的 SA 和赞比亚验证数据集中进行了评估。在 SA 培训、SA 验证和赞比亚验证数据集中，TB 病例数分别为 355、176 和 107。评分系统的曲线下面积（AUC）在 SA 验证集中为 0.68（95%CI 0.64-0.72），而延长咳嗽（0.58，95%CI 0.54-0.62）和任何 TB 症状（0.6，95%CI 0.56-0.64）的 AUC 与之相比更低。在赞比亚数据集中，评分系统的 AUC 为 0.66（95%CI 0.60-0.72）。在成本效益分析中，评分系统优于传统策略。在 SA 验证集中，每发现一个 TB 病例的成本范围为 429 至 1848 美元，在赞比亚数据集中，每发现一个 TB 病例的成本范围为 171 至 10518 美元。在预算有限的情况下，评分系统可能有助于有针对性地发现 TB 病例。
