title: Validating a scoring system for the diagnosis of smear-negative pulmonary tuberculosis in HIV-infected adults.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  From 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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Post-Graduation Program in Tropical Medicine - Federal University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Isabella
authors.initials: I
authors.lastname: Coimbra
authors.affiliation: Post-Graduation Program in Tropical Medicine - Federal University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Magda
authors.initials: M
authors.lastname: Maruza
authors.affiliation: Aggeu Magalhães Research Center/Fiocruz, Recife, Pernambuco, Brazil.
authors.forename: Maria de Fátima Pessoa Militão
authors.initials: Mde F
authors.lastname: Albuquerque
authors.affiliation: Post-Graduation Program in Tropical Medicine - Federal University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Joanna D'Arc Lyra
authors.initials: JD
authors.lastname: Batista
authors.affiliation: Aggeu Magalhães Research Center/Fiocruz, Recife, Pernambuco, Brazil.
authors.forename: Maria Cynthia
authors.initials: MC
authors.lastname: Braga
authors.affiliation: Post-Graduation Program in Tropical Medicine - Federal University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Líbia Vilela
authors.initials: LV
authors.lastname: Moura
authors.affiliation: Department of Clinical Medicine, University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Demócrito Barros
authors.initials: DB
authors.lastname: Miranda-Filho
authors.affiliation: Post-Graduation Program in Tropical Medicine - Federal University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Ulisses Ramos
authors.initials: UR
authors.lastname: Montarroyos
authors.affiliation: Post-Graduation Program in Tropical Medicine - Federal University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Heloísa Ramos
authors.initials: HR
authors.lastname: Lacerda
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Laura Cunha
authors.initials: LC
authors.lastname: Rodrigues
authors.affiliation: Post-Graduation Program in Tropical Medicine - Federal University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Ricardo Arraes de Alencar
authors.initials: RA
authors.lastname: Ximenes
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000254:growth & development; D012372:ROC Curve; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology
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