No added value of interferon-γ release to a prediction model for childhood tuberculosis

Eur Respir J. 2016 Jan;47(1):223-32. doi: 10.1183/13993003.00890-2015. Epub 2015 Oct 22.

Abstract

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.

MeSH terms

  • Adolescent
  • Age Factors
  • Algorithms
  • Area Under Curve
  • Child
  • Child, Preschool
  • Contact Tracing
  • Cough / diagnosis
  • Cough / etiology
  • Decision Support Techniques*
  • Female
  • Fever / diagnosis
  • Fever / etiology
  • Humans
  • Infant
  • Interferon-gamma Release Tests*
  • Logistic Models
  • Lymphadenopathy / diagnosis*
  • Lymphadenopathy / etiology
  • Male
  • Prospective Studies
  • ROC Curve
  • Risk Assessment
  • Tuberculosis / complications
  • Tuberculosis / diagnosis
  • Tuberculosis, Pulmonary / complications
  • Tuberculosis, Pulmonary / diagnosis*
  • Weight Loss