No added value of interferon-γ release to a prediction model for childhood tuberculosis.
The predictive value of a combination of clinical and radiological features with interferon-γ release assay (IGRA) for diagnosis of active tuberculosis (TB) disease among TB-exposed children is unknown.150 symptomatic HIV-negative children (aged 3 months to 14 years), prospectively recruited through active contact tracing, were included. Backward stepwise logistic regression and bootstrapping techniques were used for the development and internal validation of a clinical prediction model for active TB disease. Model discrimination and incremental value of a positive IGRA test were assessed by area under the receiver operating characteristic curve (AUC).35 (23%) children were diagnosed with active TB disease and started on treatment and 115 (77%) had other respiratory tract infections. A final parsimonious clinical model, comprising age <5 years (adjusted (a)OR 4.8, 95% CI 2.0-11.5) and lymphadenopathy on clinical examination (aOR 4.9, 95% CI 1.8-13.0) discriminated active TB disease from other disease with an AUC of 0.70 (95% CI 0.61-0.80). A positive IGRA result did not improve the discriminatory ability of the clinical model (c-statistic 0.72 versus 0.70; p=0.644).A clinical algorithm, including age <5 years and lymphadenopathy classified 70% of active TB disease among symptomatic TB-exposed children. IGRA does not add any discriminatory value to this prediction model.
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Banjul, The Gambia ttogun@mrc.gm.
Toyin O
TO
Togun
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Banjul, The Gambia.
Uzochukwu
U
Egere
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Banjul, The Gambia.
Marie P
MP
Gomez
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Banjul, The Gambia.
Abdou K
AK
Sillah
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Banjul, The Gambia.
Mohammed
M
Daramy
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Banjul, The Gambia.
Leopold D
LD
Tientcheu
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Banjul, The Gambia.
Jayne
J
S Sutherland
Centre for International Health and the Otago International Health Research Network, Dept of Preventive and Social Medicine, University of Otago School of Medicine, Dunedin, New Zealand.
Philip C
PC
Hill
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Banjul, The Gambia Academic Dept of Paediatrics, Imperial College London, London, UK.
Beate
B
Kampmann
D000293:Adolescent; D000367:Age Factors; D000465:Algorithms; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D003371:Cough / Q000175:diagnosis / Q000209:etiology; D003661:Decision Support Techniques; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007223:Infant; D059425:Interferon-gamma Release Tests; D016015:Logistic Models; D000072281:Lymphadenopathy / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis*; D015431:Weight Loss