Ruiz-Arabi Elisa, Castón Juan José, Páez-Vega Aurora, Fernández-Moreno Raquel, Giovagnorio Federico, Gutiérrez-Gutiérrez Belén, Cano Angela, Rodríguez-Benot Alberto, Vaquero-Barrios José M, Machuca Isabel, Vidal Elisa, Cantisán Sara, Torre-Cisneros Julián
Service of Infectious Diseases, Reina Sofia University Hospital, 14004 Córdoba, Spain.
Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba (UCO), 14004 Córdoba, Spain.
Microorganisms. 2025 Mar 4;13(3):589. doi: 10.3390/microorganisms13030589.
The cutoff value of the commercial interferon (IFN)-γ release assay (QuantiFERON-CMV) proposed by the manufacturer is assumed to be predictive. We aimed to determine the optimal cutoff value for protection against clinically significant cytomegalovirus (CMV) infection within 30 days. We analyzed two different cohorts: adult CMV seropositive kidney transplant (KT) recipients with antithymocyte globulin (ATG) induction from the TIMOVAL study and seropositive lung transplant (LT) patients from the CYTOCOR study. The optimal cutoff value was established using Youden's index. We estimated the predictive capacity of the cutoff value through the AUROC and assessed the diagnostic accuracy of the assay at the different cutoff values. We finally evaluated clinical variables that could improve the predictive ability of the assay on a predictive score. Four hundred-four samples from 130 transplant recipients were analyzed. The optimal cutoff value was ≥2.2 IU/mL for both populations, with a positive predictive value of 99% and 99.5% (95% CI, 98-100%) for KT and LT recipients, respectively. The AUROC of the predictive score was 0.85 (95% CI, 0.73-0.97). Using the proposed cutoff value and the Quanti-CMV score may allow the individualization of preventive strategies and serve as an objective tool to support clinical decision-making.
制造商提出的商用干扰素（IFN）-γ释放试验（QuantiFERON-CMV）的临界值被认为具有预测性。我们旨在确定在30天内预防具有临床意义的巨细胞病毒（CMV）感染的最佳临界值。我们分析了两个不同的队列：来自TIMOVAL研究的接受抗胸腺细胞球蛋白（ATG）诱导的成年CMV血清阳性肾移植（KT）受者和来自CYTOCOR研究的血清阳性肺移植（LT）患者。使用尤登指数确定最佳临界值。我们通过受试者工作特征曲线下面积（AUROC）评估临界值的预测能力，并评估该试验在不同临界值下的诊断准确性。我们最终评估了可以通过预测评分提高该试验预测能力的临床变量。分析了来自130名移植受者的404份样本。两个队列的最佳临界值均为≥2.2 IU/mL，KT和LT受者的阳性预测值分别为99%和99.5%（95%CI，98-100%）。预测评分的AUROC为0.85（95%CI，0.73-0.97）。使用建议的临界值和Quanti-CMV评分可能会使预防策略个体化，并作为支持临床决策的客观工具。
