Abstract
BackgroundDespite chemotherapy, patients with cured pulmonary tuberculosis may result in lung functional impairment.ObjectiveTo evaluate a novel scoring system based on the degree of radiographic abnormalities and related spirometric values in patients with cured pulmonary tuberculosis.MethodsOne hundred and twenty seven patients with cured pulmonary tuberculosis were prospectively enrolled in a referral hospital specializing in respiratory diseases. Spirometry was performed and the extent of radiographic abnormalities was evaluated twice by each of two readers to generate a novel quantitative score. Scoring reproducibility was analyzed by the intra-class correlation coefficient (ICC) and the Bland-Altman method. Multiple linear regression models were performed to assess the association of the extent of radiographic abnormalities with spirometric values.ResultsThe intra-observer agreement for scoring of radiographic abnormalities (SRA) showed an ICC of 0.81 (CI:95%, 0.67–0.95) and 0.78 (CI:95%, 0.65–0.92), for reader 1 and 2, respectively. Inter-observer reproducibility for the first measurement was 0.83 (CI:95%, 0.71–0.95), and for the second measurement was 0.74 (CI:95%, 0.58–0.90). The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an inter-observer agreement of -0.35% and -1.78%, indicating a minor average systematic variability.After adjustment for age, gender, height, smoking status, pack-years of smoking, and degree of dyspnea, the scoring degree of radiographic abnormalities was significantly and negatively associated with absolute and percent predicted values of FVC: -0.07 (CI:95%, -0.01 to -0.04); -2.48 (CI:95%, -3.45 to -1.50); and FEV1 -0.07 (CI:95%, -0.10 to -0.05); -2.92 (CI:95%, -3.87 to -1.97) respectively, in the patients studied. ConclusionThe extent of radiographic abnormalities, as evaluated through our novel scoring system, was inversely associated with spirometric values, and exhibited good reliability and reproducibility. As intra-observer and inter-observer agreement of the SRA varied from good to excellent, the use of SRA in this setting appears acceptable.
Highlights
Tuberculosis remains a significant cause of high morbidity and mortality, with 1.4 million deaths and 8.7 million new cases recorded in 2011
Median (IQR) time elapsed from the end of anti-tuberculosis treatment to inclusion in the study was 11 (6–18) months
While our study is cross-sectional, the demonstrated associations are in keeping with previous research, which indicates that cured pulmonary tuberculosis causes variable degrees and patterns of lung functional impairment [5,6,21]
Summary
Tuberculosis remains a significant cause of high morbidity and mortality, with 1.4 million deaths and 8.7 million new cases recorded in 2011. Healing occurs with progressive destruction of the parenchyma and variable degrees of fibrotic response [3]. In this context, lung remodelling in tuberculosis refers to anatomical and structural changes that are not reversed (laying down of extracellular matrix), in contrast to reversible changes, such as edema and cellular infiltration. Objective: To evaluate a novel scoring system based on the degree of radiographic abnormalities and related spirometric values in patients with cured pulmonary tuberculosis. Results: The intra-observer agreement for scoring of radiographic abnormalities (SRA) showed an ICC of 0.81 (CI: 95%, 0.67–0.95) and 0.78 (CI:95%, 0.65–0.92), for reader 1 and 2, respectively. The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an interobserver agreement of -0.35% and -1.78%, indicating a minor average systematic variability
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