Author
Listed:
- Dalila Martínez
- Gustavo Heudebert
- Carlos Seas
- German Henostroza
- Martin Rodriguez
- Carlos Zamudio
- Robert M Centor
- Cesar Herrera
- Eduardo Gotuzzo
- Carlos Estrada
Abstract
Background: Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem. Objective: To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis. Methods: Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months. Results: Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58. Conclusion: A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas.
Suggested Citation
Dalila Martínez & Gustavo Heudebert & Carlos Seas & German Henostroza & Martin Rodriguez & Carlos Zamudio & Robert M Centor & Cesar Herrera & Eduardo Gotuzzo & Carlos Estrada, 2010.
"Clinical Prediction Rule for Stratifying Risk of Pulmonary Multidrug-Resistant Tuberculosis,"
PLOS ONE, Public Library of Science, vol. 5(8), pages 1-6, August.
Handle:
RePEc:plo:pone00:0012082
DOI: 10.1371/journal.pone.0012082
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