Validating a Scoring System for the Diagnosis of Smear-Negative Pulmonary Tuberculosis in HIV-Infected Adults |
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Authors: | Isabella Coimbra Magda Maruza Maria de Fátima Pessoa Milit?o Albuquerque Joanna D’Arc Lyra Batista Maria Cynthia Braga Líbia Vilela Moura Demócrito Barros Miranda-Filho Ulisses Ramos Montarroyos Heloísa Ramos Lacerda Laura Cunha Rodrigues Ricardo Arraes de Alencar Ximenes |
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Affiliation: | 1. Post-Graduation Program in Tropical Medicine – Federal University of Pernambuco, Recife, Pernambuco, Brazil.; 2. Aggeu Magalhães Research Center/Fiocruz, Recife, Pernambuco, Brazil.; 3. Department of Clinical Medicine, University of Pernambuco, Recife, Pernambuco, Brazil.; 4. London School of Hygiene and Tropical Medicine, London, United Kingdom.; University of California, Davis, United States of America, |
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Abstract: | BackgroundThe challenge of diagnosing smear-negative pulmonary TB (tuberculosis) in people living with HIV justifies the use of instruments other than the smear test for diagnosing the disease. Considering the clinical-radiological similarities of TB amongst HIV-infected adults and children, the proposal of this study was to assess the accuracy of a scoring system used to diagnose smear-negative pulmonary TB in children and adolescents, in HIV-infected adults suspected of having smear-negative pulmonary TB.MethodsA Phase III validation study aiming to assess the diagnostic accuracy of a scoring system for diagnosing smear-negative pulmonary TB in HIV-infected adults. The study assessed sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values of the scoring system. Three versions of the scoring system were tested.ResultsFrom a cohort of 2,382 (HIV-infected adults), 1276 were investigated and 128 were diagnosed with pulmonary TB. Variables associated with the diagnosis of TB were: coughing, weight loss, fever, malnutrition, chest X-ray, and positive tuberculin test. The best diagnostic performance occurred with the scoring system with new scores, with sensitivity = 81.2% (95%-CI 74.5% –88%), specificity = 78% (75.6% –80.4%), PPV = 29.2% (24.5% –33.9%) and NPV = 97.4% (96.4% –98.4%), LR+ = 3.7 (3.4–4.0) and LR− = 0.24 (0.2–0.4).ConclusionThe proposed scoring system (with new scores) presented a good capacity for discriminating patients who did not have pulmonary TB, in the studied population. Further studies are necessary in order to validate it, thus permitting the assessment of its use in diagnosing smear-negative pulmonary TB in HIV-infected adults. |
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