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Predicting pulmonary tuberculosis in immigrants: a retrospective cohort study

Courtney Heffernan, Alexander Doroshenko, Mary Lou Egedahl, James Barrie, Ambikaipakan Senthilselvan, Richard Long
ERJ Open Research 2018 4: 00170-2017; DOI: 10.1183/23120541.00170-2017
Courtney Heffernan
1Tuberculosis Program Evaluation and Research Unit, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
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  • ORCID record for Courtney Heffernan
Alexander Doroshenko
1Tuberculosis Program Evaluation and Research Unit, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
2Division of Preventive Medicine, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
3School of Public Health, University of Alberta, Edmonton, AB, Canada
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Mary Lou Egedahl
1Tuberculosis Program Evaluation and Research Unit, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
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James Barrie
4Dept of Radiology, University of Alberta, Edmonton, AB, Canada
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Ambikaipakan Senthilselvan
3School of Public Health, University of Alberta, Edmonton, AB, Canada
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Richard Long
1Tuberculosis Program Evaluation and Research Unit, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
3School of Public Health, University of Alberta, Edmonton, AB, Canada
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  • FIGURE 1
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    FIGURE 1

    Receiver operating characteristic (ROC) curve of the prediction equation for the outcome “culture-positive” (i.e. pulmonary tuberculosis). AUC: area under the ROC curve.

  • FIGURE 2
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    FIGURE 2

    Receiver operating characteristic (ROC) curve of the prediction equation for the outcome “smear-positive” (i.e. infectious pulmonary tuberculosis). AUC: area under the ROC curve.

Tables

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  • TABLE 1

    Demographic and clinical features by pulmonary tuberculosis (TB) diagnosis status and smear status

    Culture-positiveCulture-negativep-valueSmear-positiveAll othersp-value
    Subjects17022174317
    Age years46.2±21.044.6±16.30.4245.4±21.245.3±17.80.97
    Male90 (52.9)111 (50.2)0.5941 (55.4)160 (50.4)0.44
    Clinical characteristics mean score#
     Symptoms2.7±1.141.1±0.58<0.0013.3±0.871.4±0.92<0.001
     Duration of symptoms3.0±1.241.1±0.72<0.0013.5±0.891.6±1.2<0.001
     Absence of dyspnoea3.7±0.603.9±0.22<0.0013.6±0.643.9±0.37<0.001
     Antibiotic use1.9±1.201.1±0.53<0.0012.4±1.21.2±0.75<0.001
     Epidemiological risk of acquiring Mycobacterium tuberculosis infection2.5±0.682.8±0.920.0072.3±0.542.7±0.870.002
     Risk factors for reactivation of LTBI1.4±0.821.1±0.51<0.0011.5±0.741.1±0.66<0.001
     Complete blood count2.9±0.992.1±0.64<0.0013.1±1.012.3±0.82<0.001

    Data are presented as n, mean±sd or n (%), unless otherwise stated. LTBI: latent TB infection. #: refers to the mean of the score, ranging from 1 to 4, characterising the association between the predictor and outcome from clinical experience.

    • TABLE 2

      Results from the multiple logistic regression model for culture status

      aOR (95% CI)p-value
      Age0.98 (0.96–1.00)0.05
      Male1.13 (0.62–2.07)0.67
      Clinical characteristics
       Symptoms1.79 (1.09–2.96)0.02
       Duration of symptoms2.24 (1.51–3.34)<0.001
       Absence of dyspnoea0.85 (0.36–2.00)0.71
       Antibiotic use1.16 (0.77–1.77)0.46
       Epidemiological risk of acquiring Mycobacterium tuberculosis infection1.06 (0.74–1.51)0.72
       Risk factors for reactivation of LTBI1.72 (1.08–2.72)0.02
       Complete blood count2.28 (1.58–3.31)<0.001

      aOR: adjusted OR; LTBI: latent tuberculosis infection.

      • TABLE 3

        Results from the multiple logistic regression model for infectious pulmonary tuberculosis (smear-positive, culture-positive disease)

        aOR (95% CI)p-value
        Age1.00 (0.98–1.02)0.79
        Male1.23 (0.57–265)0.59
        Chest radiograph12.34 (5.32–28.62)<0.001
        Clinical characteristics
         Symptoms2.91 (1.80–4.68)<0.001
         Duration of symptoms0.94 (0.60–1.46)0.80
         Absence of dyspnoea0.62 (0.30–1.26)0.18
         Antibiotic use1.55 (1.10–2.18)0.01
         Epidemiological risk of acquiring Mycobacterium tuberculosis infection0.94 (0.52–1.69)0.84
         Risk factors for reactivation of LTBI1.35 (0.86–2.14)0.18
         Complete blood count1.45 (0.96–2.18)0.07

        aOR: adjusted OR; LTBI: latent tuberculosis infection.

        Supplementary Materials

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        • Supplementary Material

          Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

          Scoring matrix 00170-2017_Scoring_Matrix

          Intake form 00170-2017_Intake_form

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        Predicting pulmonary tuberculosis in immigrants: a retrospective cohort study
        Courtney Heffernan, Alexander Doroshenko, Mary Lou Egedahl, James Barrie, Ambikaipakan Senthilselvan, Richard Long
        ERJ Open Research Apr 2018, 4 (2) 00170-2017; DOI: 10.1183/23120541.00170-2017

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        Predicting pulmonary tuberculosis in immigrants: a retrospective cohort study
        Courtney Heffernan, Alexander Doroshenko, Mary Lou Egedahl, James Barrie, Ambikaipakan Senthilselvan, Richard Long
        ERJ Open Research Apr 2018, 4 (2) 00170-2017; DOI: 10.1183/23120541.00170-2017
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