Clinical utility of WHO-recommended screening tools and development and validation of novel clinical prediction models for pulmonary tuberculosis screening among outpatients living with HIV: an individual participant data meta-analysis.
Eur Respir Rev
; 32(168)2023 Jun 30.
Article
en En
| MEDLINE
| ID: mdl-37286216
ABSTRACT
BACKGROUND:
The World Health Organization (WHO) recommends that outpatient people living with HIV (PLHIV) undergo tuberculosis screening with the WHO four-symptom screen (W4SS) or C-reactive protein (CRP) (5â mg·L-1 cut-off) followed by confirmatory testing if screen positive. We conducted an individual participant data meta-analysis to determine the performance of WHO-recommended screening tools and two newly developed clinical prediction models (CPMs).METHODS:
Following a systematic review, we identified studies that recruited adult outpatient PLHIV irrespective of tuberculosis signs and symptoms or with a positive W4SS, evaluated CRP and collected sputum for culture. We used logistic regression to develop an extended CPM (which included CRP and other predictors) and a CRP-only CPM. We used internal-external cross-validation to evaluate performance.RESULTS:
We pooled data from eight cohorts (n=4315 participants). The extended CPM had excellent discrimination (C-statistic 0.81); the CRP-only CPM had similar discrimination. The C-statistics for WHO-recommended tools were lower. Both CPMs had equivalent or higher net benefit compared with the WHO-recommended tools. Compared with both CPMs, CRP (5â mg·L-1 cut-off) had equivalent net benefit across a clinically useful range of threshold probabilities, while the W4SS had a lower net benefit. The W4SS would capture 91% of tuberculosis cases and require confirmatory testing for 78% of participants. CRP (5â mg·L-1 cut-off), the extended CPM (4.2% threshold) and the CRP-only CPM (3.6% threshold) would capture similar percentages of cases but reduce confirmatory tests required by 24, 27 and 36%, respectively.CONCLUSIONS:
CRP sets the standard for tuberculosis screening among outpatient PLHIV. The choice between using CRP at 5â mg·L-1 cut-off or in a CPM depends on available resources.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Tuberculosis
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Tuberculosis Pulmonar
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Infecciones por VIH
Tipo de estudio:
Diagnostic_studies
/
Prognostic_studies
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Risk_factors_studies
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Screening_studies
/
Systematic_reviews
Límite:
Adult
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Humans
Idioma:
En
Revista:
Eur Respir Rev
Año:
2023
Tipo del documento:
Article
País de afiliación:
Sudáfrica