Prognostic variables for high titres in a fluorescent antibody test to diagnose tuberculosis.
SourceRespiratory Medicine, 99, 4, (2005), pp. 477-484
Article / Letter to editor
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SubjectEBP 2: Effective Hospital Care; NCEBP 2: Evaluation of complex medical interventions; UMCN 1.5: Interventional oncology; EBP 2: Effective Hospital Care
SETTING: The four hospitals and a tuberculosis clinic in the province of Zeeland, The Netherlands. OBJECTIVE: To assess the usefulness of PPD antibody measurement in the diagnosis of tuberculosis in patients admitted to hospital. PATIENTS AND METHODS: Sixty-one patients presenting with active tuberculosis, and 215 control patients were included in the study. Initial serum PPD antibody titres were determined with a macrophage uptake Fluorescent antibody test (MuFat) to construct a discrimination model between Tuberculosis (TB) and non-TB. We also retrospectively collected clinical parameters of the TB patients at presentation. Univariate and multivariate logistic regression are used to identify variables predicting high antibody titres. Results : In TB patients, the presence of clinical symptoms (OR=10.63) and the presence of at least two concurrent non-lymph node disease localizations outside thorax and abdomen (OR=13.94) are necessary and sufficient to predict high titres. The logistic model shows a significant contribution of the 2log (titre) to the discrimination between TB and non-TB patients. At a cut-off value of 128, a specificity, sensitivity, and positive predictive and negative predictive values of 97%, 39%, 80% and 85%, respectively, are calculated in the study cohort. CONCLUSION: Our data suggest an application of the test at high cut-off values for timely diagnosis of difficult-to-diagnose TB patients. The results of this retrospective study will have to be confirmed in further prospective studies.
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