title: Clinical prediction rule for stratifying risk of pulmonary multidrug-resistant tuberculosis.
abstract: BACKGROUND
  Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem.
  
  
  OBJECTIVE
  To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis.
  
  
  METHODS
  Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months.
  
  
  RESULTS
  Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58.
  
  
  CONCLUSIONS
  A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas.
authors: Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: Dalila
authors: D
authors: Martínez
authors: Gustavo
authors: G
authors: Heudebert
authors: Carlos
authors: C
authors: Seas
authors: German
authors: G
authors: Henostroza
authors: Martin
authors: M
authors: Rodriguez
authors: Carlos
authors: C
authors: Zamudio
authors: Robert M
authors: RM
authors: Centor
authors: Cesar
authors: C
authors: Herrera
authors: Eduardo
authors: E
authors: Gotuzzo
authors: Carlos
authors: C
authors: Estrada
mesh_terms: D000293:Adolescent; D000328:Adult; D004198:Disease Susceptibility; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D014397:Tuberculosis, Pulmonary