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Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
Published on: April 9, 2012
A Nomogram Predictive Model for Drug-Resistant Tuberculosis Detection by GeneXpert MTB/RIF Assay in Paediatric
Lingchao Wang1, Weiwei Ma1, Na Wei1
1Department of Pediatric, The First Affiliated Hospital of Henan Medical University (formerly The First Affiliated Hospital of Xinxiang Medical University), Weihui, 453100, People's Republic of China.
Insights
A new nomogram effectively predicts drug-resistant tuberculosis (DR-TB) risk in pediatric patients, identifying retreatment and smoking as key factors. The GeneXpert MTB/RIF assay shows promise for early DR-TB screening in children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnostics
- Radiology and Imaging
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly in pediatric populations.
- Drug-resistant TB (DR-TB) presents a complex treatment scenario, necessitating accurate risk prediction and diagnostic tools.
- Identifying risk factors and developing predictive models for DR-TB in children is crucial for timely intervention.
Purpose of the Study:
- To develop and validate a clinical-imaging integrated nomogram for predicting DR-TB risk in pediatric patients (≤18 years).
- To evaluate the diagnostic performance of the GeneXpert MTB/RIF assay for DR-TB detection in this age group.
- To identify independent risk factors associated with DR-TB in hospitalized children and adolescents.
Main Methods:
- Retrospective study of 223 TB patients aged ≤18 years.
- Analysis of drug resistance profiles and comparison of clinical/imaging features between DR-TB and drug-susceptible TB (DS-TB) groups.
- Multivariate logistic regression to identify DR-TB risk factors and development of a nomogram predictive model.
Main Results:
- DR-TB was present in 26.5% of patients, with 13.5% having multidrug-resistant TB.
- Independent DR-TB risk factors identified: retreatment (OR=5.303), smoking history (OR=4.129), right middle lobe involvement (OR=3.004), and cavity formation (OR=2.950).
- The nomogram model demonstrated effective predictive performance (AUC=0.776). GeneXpert MTB/RIF showed 87.5% sensitivity and 90.48% specificity for rifampicin resistance.
Conclusions:
- A clinical-imaging nomogram model shows good predictive value for DR-TB risk in pediatric patients.
- Retreatment, smoking history, right middle lobe involvement, and cavity formation are significant predictors of DR-TB.
- GeneXpert MTB/RIF assay is a potential early screening tool for DR-TB in children, warranting further validation.
Objective:
To develop and validate a clinical-imaging integrated nomogram predictive model for DR-TB risk in pediatric patients (≤18 years), and to evaluate the diagnostic performance of the GeneXpert MTB/RIF assay in this context.
Methods:
This retrospective study included 223 patients with TB aged ≤18 years hospitalised between 1 July 2018 and 31 December 2023. Drug resistance profiles were analysed, and the clinical/imaging features of DR-TB were compared with those of drug-susceptible TB (DS-TB). Multivariate logistic regression was used to identify DR-TB risk factors.
Results:
Of the 223 patients, 73.5% had DS-TB and 26.5% had DR-TB (including 13.5% with multidrug-resistant TB). Resistance rates to first-line drugs were as follows: isoniazid 22.4%, rifampicin 16.1%, streptomycin 8.1% and ethambutol 3.6%. Independent DR-TB risk factors were retreatment (odds ratio [OR] = 5.303, 95% confidence interval [CI]: 1.378-20.414), smoking history (OR = 4.129, 95% CI: 1.233-13.825), right middle lobe involvement (OR = 3.004, 95% CI: 1.148-7.863) and cavity formation (OR = 2.950, 95% CI: 1.325-6.567) (all P < 0.05). A nomogram model was developed, with an area under the curve of 0.776, showing effective predictive performance and clinical utility. The GeneXpert MTB/RIF assay had 87.5% sensitivity and 90.48% specificity for detecting rifampicin resistance, with good agreement with drug susceptibility testing (kappa 0.751) (P < 0.001). No significant differences in T-lymphocyte subsets were found between the DR-TB and DS-TB groups.
Conclusion:
In children and adolescents, TB is more common in older individuals and consists primarily of new cases. The nomogram model has good predictive value for DR-TB risk. Key predictors include retreatment, smoking, right middle lobe involvement and cavity formation. The GeneXpert MTB/RIF assay is a potential early screening tool for DR-TB. Further validation with larger samples is needed.
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