评价临床预测指标在估计埃塞俄比亚北部涂片阴性肺结核病例中的概率的性能：一项横断面研究。

Evaluation of the performance of clinical predictors in estimating the probability of pulmonary tuberculosis among smear-negative cases in Northern Ethiopia: a cross-sectional study.

机构信息

Department of Biomedical Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia

Department of Family Medicine, CAPHRI School of Public Health and Primary Care/Maastricht University, Maastricht, The Netherlands.

出版信息

BMJ Open. 2020 Nov 3;10(11):e037913. doi: 10.1136/bmjopen-2020-037913.

DOI:10.1136/bmjopen-2020-037913

PMID:33148731

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7640509/

Abstract

OBJECTIVES

To evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests.

DESIGN

A cross-sectional study.

SETTING

Two public referral hospitals in Tigray, Ethiopia.

PARTICIPANTS

A total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

A total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done.

RESULTS

The strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84-0.87) and culture-negative (AUC 0.64-0.69) PTB.

CONCLUSIONS

Our finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.

摘要

目的

评估预测因子在综合所有有意义变量和仅综合显著变量时，分别在（1）所有临床疑似患者和（2）培养试验结果为阴性的涂片病例中，对肺结核（PTB）概率的预测性能。

设计

横断面研究。

地点

埃塞俄比亚提格雷的两家公立转诊医院。

参与者

根据国家结核病和麻风病规划的埃塞俄比亚指南，对因临床疑似患肺结核而入院的 426 例连续成年患者进行了痰涂片显微镜检查和胸部 X 线检查（胸片（CXR））。排除标准为过去 3 个月内中断抗结核治疗、无痰、HIV 阳性和不愿书面同意。

主要和次要结局测量

共有 354 例患者纳入最终分析，72 例患者因未进行培养试验而被排除。

结果

在有临床疑似的患者中，培养阳性 PTB 的最强预测变量是阳性涂片检查（OR 172；95%CI 23.23-1273.54）和与 PTB 相符的 CXR 病变（OR 10.401；95%CI 5.862-18.454）。该回归模型对识别有临床疑似的培养阳性 PTB 具有良好的预测性能（曲线下面积（AUC）为 0.84），但对涂片阴性结果的患者预测效果较差（AUC 为 0.64）。与仅纳入独立显著变量相比，在模型中综合所有预测因子并未真正提高其识别培养阳性（AUC 为 0.84-0.87）和培养阴性（AUC 为 0.64-0.69）PTB 的性能。