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European Radiology

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01-01-2018 | Chest

Validation of a model for predicting smear-positive active pulmonary tuberculosis in patients with initial acid-fast bacilli smear-negative sputum

Author: Jun -Jun Yeh

Published in: European Radiology | Issue 1/2018

Abstract

Objectives

The objective of this study was to develop a predictive model for final smear-positive (SP) active pulmonary tuberculosis (aPTB) in patients with initial negative acid fast bacilli (AFB) sputum smears (iSN-SP-aPTB) based on high-resolution computed tomography (HRCT).

Method and materials

Eighty (126, 21) patients of iSN-SP-aPTB and 402 (459, 876) patients of non-initial positive acid fast bacilli (non-iSP) pulmonary disease without iSN-SP-aPTB were included in a derivation (validation, prospective) cohort. HRCT characteristics were analysed, and multivariable regression and receiver operating characteristic (ROC) curve analysis was performed to develop a score predictive of iSN-SP-aPTB.

Results

The derivation cohort showed clusters of nodules/mass of the right upper lobe or left upper lobe were independent predictors of iSN-SP-aPTB, while bronchiectasis in the right middle lobe or left lingual lobe were negatively associated with iSN-SP-aPTB. A predictive score for iSN-SP-aPTB based on these findings was tested in the validation and prospective cohorts. With an ideal cut-off score = 1, the sensitivity, specificity, positive predictive value, and negative predictive value of the prediction model were 87.5% (90%, 90.5%), 99% (97.1%, 98.4%), 94.6% (81.3%, 57.5%), and 97.6% (97%, 99.8%) in the derivation (validation, prospective) cohorts, respectively.

Conclusions

The model may help identify iSN-SP-aPTB among patients with non-iSP pulmonary diseases.

Key Points

• Smear-positive active pulmonary tuberculosis that is initial smear-negative (iSN-SP-aPTB) is infectious.

• High-resolution computed tomography can identify iSN-SP-aPTB among non-iSP pulmonary diseases.

• Clusters nodules/mass in right/left upper lobe are positively associated with iSN-SP-aPTB.

• Bronchiectasis in right middle/left lingual lobe is negatively associated with iSN-SP-aPTB.

• The model may have high post-test probability in identifying iSN-SP-aPTB.

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Title: Validation of a model for predicting smear-positive active pulmonary tuberculosis in patients with initial acid-fast bacilli smear-negative sputum
Author: Jun -Jun Yeh
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 1/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4959-9

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Validation of a model for predicting smear-positive active pulmonary tuberculosis in patients with initial acid-fast bacilli smear-negative sputum

Abstract

Objectives

Method and materials

Results

Conclusions

Key Points

At a glance: The ONWARDS insulin icodec trials

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Abstract

Objectives

Method and materials

Results

Conclusions

Key Points

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