Predictors of Initial Smear-Negative Active Pulmonary Tuberculosis with Acute Early Stage Lung Injury by High-Resolution Computed Tomography and Clinical Manifestations: An Auxiliary Model in Critical Patients

Jun-Jun Yeh

doi:10.1038/s41598-019-40799-w

Abstract

This study evaluated the diagnostic use of high-resolution computed tomography (HRCT), chest X-ray (CXR), and clinical manifestations (CM) to identify initial smear-negative (iSN) active pulmonary tuberculosis (aPTB) [iSN-aPTB] in patients with iSN-pulmonary diseases (PD) and acute lung injury (ALI). In the derivation cohort, the [iSN-PD] with ALI patients were divided into the [iSN-aPTB] (G1, n = 26) and [non-aPTB-PD] (G2, n = 233) groups. Lung morphology, number, and lobar (segmental) distribution were evaluated using CXR and HRCT. A multivariate analysis was performed to identify independent variables associated with G1, which were used to generate predictive score models for G1. The predictive model was validated in a separate population of patients (n = 372) with [iSN-PD] and (ALI). The validated model for [HRCT (CXR + Hypoalbuminemia)] had 93.5% (25.8%) sensitivity, 99.5% (89.4%) specificity, and a negative predictive value of 99.5% (93.0%). For [iSN-aPTB], the post-test probability in the derivation cohort (prevalence = 10%), validation cohort (prevalence = 8.3%), and the given prevalence (prevalence = 1%) was 88.7%, 94.4%, and 41.5%, respectively. The HRCT model effectively identified the [iSN-aPTB] subjects among the [iSN-PD] with ALI, regardless of CM. The [non-aPTB-PD] were also correctly classified by the HRCT and [CXR + Hypoalbuminemia] models.

Highlights

Tuberculosis (TB) is a major health problem around the world, and early diagnosis is critical for control of TB
This study evaluated the diagnostic use of high-resolution computed tomography (HRCT), chest X-ray (CXR), and clinical manifestations (CM) to identify initial smear-negative active pulmonary tuberculosis [iSN-active pulmonary TB (aPTB)] in patients with iSN-pulmonary diseases (PD) and acute lung injury (ALI)
Clinical characteristics were similar between the G1 and G2 groups, including age, sex, previous TB, diabetes mellitus (DM), steroid use, chronic obstructive pulmonary disease (COPD), liver cirrhosis, uremia, upper gastrointestinal bleeding, lymphopenia, neutropenia, levels of white blood cells, and other clinical signs and symptoms

Summary

Introduction

Tuberculosis (TB) is a major health problem around the world, and early diagnosis is critical for control of TB. Contagious active pulmonary TB (aPTB) commonly presents with vague clinical symptoms such as fever, weight loss, chronic productive cough, and occasional dyspnea and hemoptysis[1]. These signs can be mistaken for community-acquired pneumonia and can be missed on the initial diagnosis in the emergency department, thereby increasing the risk of nosocomial infection and additional transmission of the disease to the general population[2]. The accuracy of HRCT and CXR in patients with ALI (eg, such as ARDS) for diagnosing initial smear-negative active pulmonary tuberculosis (iSN-aPTB) in early stage ALI is not well understood

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