Clinical Prediction Rule for Stratifying Risk of Pulmonary Multidrug-Resistant Tuberculosis

Dalila Martínez, Gustavo Heudebert, Carlos Seas, German Henostroza, Martin Rodriguez, Carlos Zamudio, Robert M Centor, Cesar Herrera, Eduardo Gotuzzo and Carlos Estrada

PLOS ONE, 2010, vol. 5, issue 8, 1-6

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.

Date: 2010
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0012082

DOI: 10.1371/journal.pone.0012082

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