Clinical prediction rule for stratifying risk of pulmonary multidrug-resistant tuberculosis.
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.
Martínez
Dalila
D
Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Heudebert
Gustavo
G
Seas
Carlos
C
Henostroza
German
G
Rodriguez
Martin
M
Zamudio
Carlos
C
Centor
Robert M
RM
Herrera
Cesar
C
Gotuzzo
Eduardo
E
Estrada
Carlos
C
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