Division of Tuberculosis Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China.
Family Health International Office, Kunming, China.
BMC Infect Dis. 2022 Apr 19;22(1):388. doi: 10.1186/s12879-022-07368-5.
Diagnosis of pulmonary tuberculosis (PTB) among people living with HIV (PLHIV) was challenging. The study aimed to develop and validated a simple, convenient screening model for prioritizing TB among PLHIV.
The study included eligible adult PLHIV participants who attended health care in Yunnan, China, from January 2016 to July 2019. Participants included before June 2018 were in the primary set; others were in the independent validation set. The research applied the least absolute shrinkage and selection operator regression to identify predictors associated with bacteriological confirmed PTB. The TB nomogram was developed by multivariate logistic regression. The C-index, receiver operating characteristic curve (ROC), the Hosmer-Lemeshow goodness of fit test (H-L), and the calibration curves were applied to evaluate and calibrate the nomogram. The developed nomogram was validated in the validation set. The clinical usefulness was assessed by cutoff analysis and decision curve analysis in the primary set.
The study enrolled 766 PLHIV, of which 507 were in the primary set and 259 in the validation set, 21.5% and 14.3% individuals were confirmed PTB in two sets, respectively. The final nomogram included 5 predictors: current CD 4 cell count, the number of WHO screen tool, previous TB history, pulmonary cavity, and smoking status (p < 0.05). The C-statistic was 0.72 (95% CI 0.66-0.77) in primary set and 0.68 (95% CI 0.58-0.75) in validation set, ROC performed better than other models. The nomogram calibration was good (H-L χ = 8.14, p = 0.15). The area under the decision curve (0.025) outperformed the existing models. The optimal cutoff for screening TB among PLHIV was the score of 100 (sensitivity = 0.93, specificity = 0.35).
The study developed and validated a discriminative TB nomogram among PLHIV in the moderate prevalence of TB and HIV. The easy-to-use and straightforward nomogram would be beneficial for clinical practice and rapid risk screening in resource-limited settings.
在 HIV 感染者（PLHIV）中诊断肺结核（PTB）具有挑战性。本研究旨在开发和验证一种简单、方便的筛选模型，以优先考虑 PLHIV 中的结核病。
本研究纳入了 2016 年 1 月至 2019 年 7 月在中国云南接受医疗保健的符合条件的成年 PLHIV 参与者。2018 年 6 月之前纳入的参与者为初级组；其他参与者为独立验证组。研究应用最小绝对收缩和选择算子回归来识别与细菌学证实的 PTB 相关的预测因素。通过多变量逻辑回归开发了 TB 列线图。应用 C 指数、受试者工作特征曲线（ROC）、Hosmer-Lemeshow 拟合优度检验（H-L）和校准曲线来评估和校准列线图。在验证组中验证了开发的列线图。在初级组中通过截断分析和决策曲线分析评估其临床实用性。
本研究共纳入 766 名 PLHIV，其中 507 名在初级组，259 名在验证组，两组分别有 21.5%和 14.3%的个体被确诊为 PTB。最终的列线图包括 5 个预测因素：当前 CD4 细胞计数、世卫组织筛查工具数量、既往结核病史、肺空洞和吸烟状况（p<0.05）。初级组的 C 统计量为 0.72（95%CI 0.66-0.77），验证组为 0.68（95%CI 0.58-0.75），ROC 表现优于其他模型。列线图校准良好（H-L χ=8.14，p=0.15）。决策曲线下面积（0.025）优于现有模型。筛查 PLHIV 结核病的最佳截断值为 100 分（灵敏度=0.93，特异性=0.35）。
本研究在结核病和 HIV 中度流行的情况下，开发和验证了一种用于 PLHIV 的具有鉴别力的结核病列线图。易于使用和简单的列线图将有益于资源有限环境中的临床实践和快速风险筛查。
