A multi-parameter diagnostic clinical decision tree for the rapid diagnosis of tuberculosis in HIV-positive patients presenting to an emergency centre.
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| Title: | A multi-parameter diagnostic clinical decision tree for the rapid diagnosis of tuberculosis in HIV-positive patients presenting to an emergency centre. |
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| Authors: | van Hoving, Daniël Jacobus1,2 nvhoving@sun.ac.za, Meintjes, Graeme3,4, Maartens, Gary5, Kengne, Andre Pascal4,6 |
| Source: | Wellcome Open Research. 2022, Vol. 7, p1-32. 32p. |
| Subject Terms: | Tuberculosis diagnosis, HIV-positive persons, Emergency medical services, Mortality, Point-of-care testing, Decision trees |
| Abstract: | Background: Early diagnosis is essential to reduce the morbidity and mortality of HIV-associated tuberculosis. We developed a multiparameter clinical decision tree to facilitate rapid diagnosis of tuberculosis using point-of-care diagnostic tests in HIV-positive patients presenting to an emergency centre. Methods: A cross-sectional study was performed in a district hospital emergency centre in a high-HIV-prevalence community in South Africa. Consecutive HIV-positive adults with ≥1 WHO tuberculosis symptoms were enrolled over a 16-month period. Point-of-care ultrasound (PoCUS) and urine lateral flow lipoarabinomannan (LFLAM) assay were done according to standardized protocols. Participants also received a chest X-ray. Reference standard was the detection of Mycobacterium tuberculosis using Xpert MTB/RIF or culture. Logistic regressions models were used to investigate the independent association between prevalent microbiologically confirmed tuberculosis and clinical and biological variables of interest. A decision tree model to predict tuberculosis was developed using the classification and regression tree algorithm. Results: There were 414 participants enrolled: 171 male, median age 36 years, median CD4 cell count 86 cells/mm3. Tuberculosis prevalence was 42% (n=172). Significant variables used to build the classification tree included ≥2 WHO symptoms, antiretroviral therapy use, LF-LAM, PoCUS independent features (pericardial effusion, ascites, intra-abdominal lymphadenopathy) and chest X-ray. LF-LAM was positioned after WHO symptoms (75% true positive rate, representing 17% of study population). Chest X-ray should be performed next if LFLAM is negative. The presence of ≤1 PoCUS independent feature in those with ‘possible or unlikely tuberculosis’ on chest x-ray represented 47% of non-tuberculosis participants (true negative rate 83%). In a prediction tree which only included true point-of-care tests, a negative LF-LAM and the presence of ≤2 independent PoCUS features had a 71% true negative rate (representing 53% of sample). Conclusions: LF-LAM should be performed in all adults with suspected HIV-associated tuberculosis (regardless of CD4 cell count) presenting to the emergency centre. [ABSTRACT FROM AUTHOR] |
| Copyright of Wellcome Open Research is the property of Wellcome Trust and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | GreenFILE |
| FullText | Text: Availability: 0 |
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| Header | DbId: 8gh DbLabel: GreenFILE An: 174043055 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: A multi-parameter diagnostic clinical decision tree for the rapid diagnosis of tuberculosis in HIV-positive patients presenting to an emergency centre. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22van+Hoving%2C+Daniël+Jacobus%22">van Hoving, Daniël Jacobus</searchLink><relatesTo>1,2</relatesTo><i> nvhoving@sun.ac.za</i><br /><searchLink fieldCode="AR" term="%22Meintjes%2C+Graeme%22">Meintjes, Graeme</searchLink><relatesTo>3,4</relatesTo><br /><searchLink fieldCode="AR" term="%22Maartens%2C+Gary%22">Maartens, Gary</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Kengne%2C+Andre+Pascal%22">Kengne, Andre Pascal</searchLink><relatesTo>4,6</relatesTo> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Wellcome+Open+Research%22">Wellcome Open Research</searchLink>. 2022, Vol. 7, p1-32. 32p. – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22Tuberculosis+diagnosis%22">Tuberculosis diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22HIV-positive+persons%22">HIV-positive persons</searchLink><br /><searchLink fieldCode="DE" term="%22Emergency+medical+services%22">Emergency medical services</searchLink><br /><searchLink fieldCode="DE" term="%22Mortality%22">Mortality</searchLink><br /><searchLink fieldCode="DE" term="%22Point-of-care+testing%22">Point-of-care testing</searchLink><br /><searchLink fieldCode="DE" term="%22Decision+trees%22">Decision trees</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background: Early diagnosis is essential to reduce the morbidity and mortality of HIV-associated tuberculosis. We developed a multiparameter clinical decision tree to facilitate rapid diagnosis of tuberculosis using point-of-care diagnostic tests in HIV-positive patients presenting to an emergency centre. Methods: A cross-sectional study was performed in a district hospital emergency centre in a high-HIV-prevalence community in South Africa. Consecutive HIV-positive adults with ≥1 WHO tuberculosis symptoms were enrolled over a 16-month period. Point-of-care ultrasound (PoCUS) and urine lateral flow lipoarabinomannan (LFLAM) assay were done according to standardized protocols. Participants also received a chest X-ray. Reference standard was the detection of Mycobacterium tuberculosis using Xpert MTB/RIF or culture. Logistic regressions models were used to investigate the independent association between prevalent microbiologically confirmed tuberculosis and clinical and biological variables of interest. A decision tree model to predict tuberculosis was developed using the classification and regression tree algorithm. Results: There were 414 participants enrolled: 171 male, median age 36 years, median CD4 cell count 86 cells/mm3. Tuberculosis prevalence was 42% (n=172). Significant variables used to build the classification tree included ≥2 WHO symptoms, antiretroviral therapy use, LF-LAM, PoCUS independent features (pericardial effusion, ascites, intra-abdominal lymphadenopathy) and chest X-ray. LF-LAM was positioned after WHO symptoms (75% true positive rate, representing 17% of study population). Chest X-ray should be performed next if LFLAM is negative. The presence of ≤1 PoCUS independent feature in those with ‘possible or unlikely tuberculosis’ on chest x-ray represented 47% of non-tuberculosis participants (true negative rate 83%). In a prediction tree which only included true point-of-care tests, a negative LF-LAM and the presence of ≤2 independent PoCUS features had a 71% true negative rate (representing 53% of sample). Conclusions: LF-LAM should be performed in all adults with suspected HIV-associated tuberculosis (regardless of CD4 cell count) presenting to the emergency centre. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Wellcome Open Research is the property of Wellcome Trust and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.12688/wellcomeopenres.15824.1 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 32 StartPage: 1 Subjects: – SubjectFull: Tuberculosis diagnosis Type: general – SubjectFull: HIV-positive persons Type: general – SubjectFull: Emergency medical services Type: general – SubjectFull: Mortality Type: general – SubjectFull: Point-of-care testing Type: general – SubjectFull: Decision trees Type: general Titles: – TitleFull: A multi-parameter diagnostic clinical decision tree for the rapid diagnosis of tuberculosis in HIV-positive patients presenting to an emergency centre. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: van Hoving, Daniël Jacobus – PersonEntity: Name: NameFull: Meintjes, Graeme – PersonEntity: Name: NameFull: Maartens, Gary – PersonEntity: Name: NameFull: Kengne, Andre Pascal IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Text: 2022 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 2398502X Numbering: – Type: volume Value: 7 Titles: – TitleFull: Wellcome Open Research Type: main |
| ResultId | 1 |
