Cortes Melissa P, Schultz Carrie S, Isha Shahin, Sinclair Jorge E, Bhakta Shivang, Kunze Katie L, Johnson Patrick W, Cowart Jennifer B, Carter Rickey E, Franco Pablo Moreno, Sanghavi Devang K, Roy Archana
Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL.
Department of Critical Care, Mayo Clinic, Jacksonville, FL.
Mayo Clin Proc Innov Qual Outcomes. 2022 Oct;6(5):409-419. doi: 10.1016/j.mayocpiqo.2022.06.004. Epub 2022 Jul 7.
To assess the proportion of indeterminate QuantiFERON-TB Gold Plus (QFT-Plus) results in patients admitted for severe coronavirus disease 2019 (COVID-19) pneumonia and evaluate the factors associated with indeterminate QFT-Plus results.
Data on COVID-19 admissions at Mayo Clinic in Florida were extracted between October 13, 2020, and September 20, 2021, and data from a prepandemic cohort were extracted between October 13, 2018, and September 20, 2019. A secondary analysis of the COVID-19 cohort was performed using gradient boosting modeling to generate variable importance and SHapley Additive exPlanations plots.
Our findings demonstrated more indeterminate QFT-Plus test results in patients hospitalized for severe COVID-19 infection than in patients without COVID-19 (139 of 495, 28.1%). The factors associated with indeterminate QFT-Plus test results included elevated levels of C-reactive protein, ferritin, lactate dehydrogenase and interleukin-6 and included lower levels of leukocyte, lymphocyte, and platelet counts.
The patients with severe COVID-19 had a higher likelihood of indeterminate QFT-Plus results, which were associated with elevated levels of inflammatory markers consistent with severe infection. Interferon-gamma release assay screening tests are likely confounded by COVID-19 infection itself, limiting the screening ability for latent tuberculosis infection reactivation. Indeterminate QFT-Plus results may also require follow-up QFT-Plus testing after patient recovery from COVID-19, increasing the cost and complexity of medical decision making and management. Additional risk assessments may be needed in this patient population for screening for latent tuberculosis infection in patients with severe COVID-19.
评估因严重2019冠状病毒病（COVID-19）肺炎入院患者中QuantiFERON-TB Gold Plus（QFT-Plus）检测结果不确定的比例，并评估与QFT-Plus检测结果不确定相关的因素。
提取2020年10月13日至2021年9月20日佛罗里达州梅奥诊所COVID-19入院患者的数据，以及2018年10月13日至2019年9月20日疫情前队列的数据。对COVID-19队列进行二次分析，使用梯度提升模型生成变量重要性和SHapley加性解释图。
我们的研究结果表明，因严重COVID-19感染住院的患者中QFT-Plus检测结果不确定的情况比未感染COVID-19的患者更多（495例中有139例，占28.1%）。与QFT-Plus检测结果不确定相关的因素包括C反应蛋白、铁蛋白、乳酸脱氢酶和白细胞介素-6水平升高，以及白细胞、淋巴细胞和血小板计数较低。
严重COVID-19患者QFT-Plus检测结果不确定的可能性更高，这与严重感染时炎症标志物水平升高有关。干扰素-γ释放试验筛查可能会受到COVID-19感染本身的干扰，限制了对潜伏性结核感染再激活的筛查能力。QFT-Plus检测结果不确定可能还需要在患者从COVID-19康复后进行后续QFT-Plus检测，增加了医疗决策和管理的成本与复杂性。对于这一患者群体，可能需要进行额外的风险评估，以筛查严重COVID-19患者的潜伏性结核感染。
