In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 17, No. 11 ( 2020-11-10), p. e1003420-
Abstract:
In highly resource-limited settings, many clinics lack same-day microbiological testing for active tuberculosis (TB). In these contexts, risk of pretreatment loss to follow-up is high, and a simple, easy-to-use clinical risk score could be useful. Methods and findings We analyzed data from adults tested for TB with Xpert MTB/RIF across 28 primary health clinics in rural South Africa (between July 2016 and January 2018). We used least absolute shrinkage and selection operator regression to identify characteristics associated with Xpert-confirmed TB and converted coefficients into a simple score. We assessed discrimination using receiver operating characteristic (ROC) curves, calibration using Cox linear logistic regression, and clinical utility using decision curves. We validated the score externally in a population of adults tested for TB across 4 primary health clinics in urban Uganda (between May 2018 and December 2019). Model development was repeated de novo with the Ugandan population to compare clinical scores. The South African and Ugandan cohorts included 701 and 106 individuals who tested positive for TB, respectively, and 686 and 281 randomly selected individuals who tested negative. Compared to the Ugandan cohort, the South African cohort was older (41% versus 19% aged 45 years or older), had similar breakdown of biological sex (48% versus 50% female), and had higher HIV prevalence (45% versus 34%). The final prediction model, scored from 0 to 10, included 6 characteristics: age, sex, HIV (2 points), diabetes, number of classical TB symptoms (cough, fever, weight loss, and night sweats; 1 point each), and 〉 14-day symptom duration. Discrimination was moderate in the derivation (c-statistic = 0.82, 95% CI = 0.81 to 0.82) and validation (c-statistic = 0.75, 95% CI = 0.69 to 0.80) populations. A patient with 10% pretest probability of TB would have a posttest probability of 4% with a score of 3/10 versus 43% with a score of 7/10. The de novo Ugandan model contained similar characteristics and performed equally well. Our study may be subject to spectrum bias as we only included a random sample of people without TB from each cohort. This score is only meant to guide management while awaiting microbiological results, not intended as a community-based triage test (i.e., to identify individuals who should receive further testing). Conclusions In this study, we observed that a simple clinical risk score reasonably distinguished individuals with and without TB among those submitting sputum for diagnosis. Subject to prospective validation, this score might be useful in settings with constrained diagnostic resources where concern for pretreatment loss to follow-up is high.
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003420
DOI:
10.1371/journal.pmed.1003420.g001
DOI:
10.1371/journal.pmed.1003420.g002
DOI:
10.1371/journal.pmed.1003420.g003
DOI:
10.1371/journal.pmed.1003420.g004
DOI:
10.1371/journal.pmed.1003420.g005
DOI:
10.1371/journal.pmed.1003420.t001
DOI:
10.1371/journal.pmed.1003420.t002
DOI:
10.1371/journal.pmed.1003420.s001
DOI:
10.1371/journal.pmed.1003420.s002
DOI:
10.1371/journal.pmed.1003420.s003
DOI:
10.1371/journal.pmed.1003420.s004
DOI:
10.1371/journal.pmed.1003420.s005
DOI:
10.1371/journal.pmed.1003420.s006
DOI:
10.1371/journal.pmed.1003420.s007
DOI:
10.1371/journal.pmed.1003420.s008
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10.1371/journal.pmed.1003420.s009
DOI:
10.1371/journal.pmed.1003420.s010
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10.1371/journal.pmed.1003420.s011
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10.1371/journal.pmed.1003420.s012
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10.1371/journal.pmed.1003420.s013
DOI:
10.1371/journal.pmed.1003420.s014
DOI:
10.1371/journal.pmed.1003420.s015
DOI:
10.1371/journal.pmed.1003420.s016
DOI:
10.1371/journal.pmed.1003420.s017
DOI:
10.1371/journal.pmed.1003420.s018
DOI:
10.1371/journal.pmed.1003420.s019
DOI:
10.1371/journal.pmed.1003420.s020
DOI:
10.1371/journal.pmed.1003420.s021
DOI:
10.1371/journal.pmed.1003420.s022
DOI:
10.1371/journal.pmed.1003420.r001
DOI:
10.1371/journal.pmed.1003420.r002
DOI:
10.1371/journal.pmed.1003420.r003
DOI:
10.1371/journal.pmed.1003420.r004
DOI:
10.1371/journal.pmed.1003420.r005
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2020
detail.hit.zdb_id:
2164823-2
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