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A Diagnostic Prediction Model for Distinguishing Pulmonary Tuberculosis from the Positive Sputum Acid-Fast Bacteria Smear Test Patients
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A5564 - A Diagnostic Prediction Model for Distinguishing Pulmonary Tuberculosis from the Positive Sputum Acid-Fast Bacteria Smear Test Patients
Author Block: H. Kanemura1, A. Kitamura2, R. Imai2, K. Ishii2, R. Tsugitomi2, K. Okafuji2, Y. Tomishima2, T. Jinta2, N. Nishimura2, D. Kobayashi2, T. Tamura2; 1Division of Pulmonary Medicine, St. Luke’s International Hospital, Tokyo, Japan, 2St. Luke’s International Hospital, Tokyo, Japan.
Rationale: In patients with positive sputum acid-fast bacteria smear test, it is difficult to distinguish pulmonary tuberculosis (TB) from non-tuberculous mycobacteria (NTM) and to start the treatment for pulmonary tuberculosis. The objective of this study was to create a model for predicting whether a patient with positive sputum acid-fast bacteria smear test positive has the diagnosis of TB. Method: We conducted a retrospective cohort study in patients with positive sputum acid-fast bacteria smear test who presented to our hospital from January 2004 to May 2017. Medical history, social factors, symptom and chest computed tomography (CT) scan pattern were obtained from medical records. The primary outcome was the diagnosis of TB by polymerase chain reaction or culture of the sputum. Using logistic multivariate regression analysis (stepwise forward selection (Wald)) the factors were extracted. Results: Of 113 patients, 69 were diagnosed TB. The median age was 68 (24-98) and 63 (55.8%) were male. No NTM history (odds ratio (OR): 30.6, 95%CI 2.4 - 399.4), cough > 2 week’s duration (OR: 4.5, 95%CI 1.2 - 17.8), fever (OR: 10.2, 95%CI 2.5 - 42.1), no bronchiectasis on CT(OR: 4.7, 95%CI 1.2 - 17.8) and no lingular segmental lesion on CT(OR: 9.0, 95%CI 2.7 - 30.9) were significantly associated with smear positive pulmonary tuberculosis. A diagnostic prediction model with a total score of 7 points was constructed as follows: 2 points for no NTM history; 1.5 points each for fever and no lingular segmental lesion on CT; 1 point each for cough > 2 week’s duration and no bronchiectasis on CT. Area under the receiver operating characteristic (ROC) curve for this model was 85.9% (95% CI: 78.7-93.1%). When a total score is less than 3 points, a sensitivity is 98.6% and a negative predictive value is 95.8%. Conclusions: Our diagnostic prediction model for the diagnosis of TB included five clinical predictors that are readily available in the clinical setting and showed a relatively high accuracy.
Author Block: H. Kanemura1, A. Kitamura2, R. Imai2, K. Ishii2, R. Tsugitomi2, K. Okafuji2, Y. Tomishima2, T. Jinta2, N. Nishimura2, D. Kobayashi2, T. Tamura2; 1Division of Pulmonary Medicine, St. Luke’s International Hospital, Tokyo, Japan, 2St. Luke’s International Hospital, Tokyo, Japan.
Rationale: In patients with positive sputum acid-fast bacteria smear test, it is difficult to distinguish pulmonary tuberculosis (TB) from non-tuberculous mycobacteria (NTM) and to start the treatment for pulmonary tuberculosis. The objective of this study was to create a model for predicting whether a patient with positive sputum acid-fast bacteria smear test positive has the diagnosis of TB. Method: We conducted a retrospective cohort study in patients with positive sputum acid-fast bacteria smear test who presented to our hospital from January 2004 to May 2017. Medical history, social factors, symptom and chest computed tomography (CT) scan pattern were obtained from medical records. The primary outcome was the diagnosis of TB by polymerase chain reaction or culture of the sputum. Using logistic multivariate regression analysis (stepwise forward selection (Wald)) the factors were extracted. Results: Of 113 patients, 69 were diagnosed TB. The median age was 68 (24-98) and 63 (55.8%) were male. No NTM history (odds ratio (OR): 30.6, 95%CI 2.4 - 399.4), cough > 2 week’s duration (OR: 4.5, 95%CI 1.2 - 17.8), fever (OR: 10.2, 95%CI 2.5 - 42.1), no bronchiectasis on CT(OR: 4.7, 95%CI 1.2 - 17.8) and no lingular segmental lesion on CT(OR: 9.0, 95%CI 2.7 - 30.9) were significantly associated with smear positive pulmonary tuberculosis. A diagnostic prediction model with a total score of 7 points was constructed as follows: 2 points for no NTM history; 1.5 points each for fever and no lingular segmental lesion on CT; 1 point each for cough > 2 week’s duration and no bronchiectasis on CT. Area under the receiver operating characteristic (ROC) curve for this model was 85.9% (95% CI: 78.7-93.1%). When a total score is less than 3 points, a sensitivity is 98.6% and a negative predictive value is 95.8%. Conclusions: Our diagnostic prediction model for the diagnosis of TB included five clinical predictors that are readily available in the clinical setting and showed a relatively high accuracy.
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