Clinical-Laboratory Prediction Rule Derivation for Pulmonary Tuberculosis Diagnosis in General Hospitals in a High-Burden Country

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Abstract

Background

Clinical prediction rules (CPR) for pulmonary tuberculosis (PTB) diagnosis in the hospital setting in countries with high prevalence of PTB are rare.

Methods

With the purpose to derive a CPR for PTB and assess its accuracy in patients 15 years or older admitted to a general hospital in Rio de Janeiro city, Brazil, a diagnostic accuracy study was conducted with hospitalized patients from 2008 to 2013. Reference standard: positive Mycobacterium tuberculosis culture in respiratory specimens. Logistic regression-adjusted odds ratios, receiver operating characteristic curve of the value predicted by the model and its accuracy parameters were calculated.

Results

This study assessed 284 patients, 52 with PTB (18.3%). The score of the derived CPR ranged from 0 to 5, 2 points being attributed to fever and 1 to each of the following predictors: weight loss greater than 10%, alcohol consumption and typical/compatible chest imaging. The cutoff point was 3 or greater, with 0.70 area under the receiver operating characteristic curve, 72.1% sensitivity, 64.5% specificity, 30.1% and 91.6% positive and negative predictive values, respectively, and 2.0 and 0.4 positive and negative likelihood ratios, respectively.

Conclusions

The derived CPR corroborated the result of a recent systematic review of PTB predictors for hospitalized patients, but should be prospectively validated. The high false-positive rate justifies its combination with PTB-specific tests.

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