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Development of a Clinical Prediction Score Including Monocyte-to-Lymphocyte Ratio to Inform Tuberculosis Treatment Among Children With HIV: A Multicountry Study

dc.rights.licenseopenen_US
dc.contributor.authorMALIK, Amyn A.
dc.contributor.authorGANDHI, Neel R.
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorMARCY, Olivier
dc.contributor.authorWALTERS, Elisabetta
dc.contributor.authorTEJIOKEM, Mathurin
dc.contributor.authorCHAU, Giang Do
dc.contributor.authorOMER, Saad B.
dc.contributor.authorLASH, Timothy L.
dc.contributor.authorBECERRA, Mercedes C.
dc.contributor.authorNJUGUNA, Irene N.
dc.contributor.authorLACOURSE, Sylvia M.
dc.contributor.authorMALECHE-OBIMBO, Elizabeth
dc.contributor.authorWAMALWA, Dalton
dc.contributor.authorJOHN-STEWART, Grace C.
dc.contributor.authorCRANMER, Lisa M.
dc.date.accessioned2022-12-16T12:55:00Z
dc.date.available2022-12-16T12:55:00Z
dc.date.issued2022-11
dc.identifier.issn2328-8957 (Print) 2328-8957en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/171547
dc.description.abstractEnBACKGROUND: Clinical pediatric tuberculosis (TB) diagnosis may lead to overdiagnosis particularly among children with human immunodeficiency virus (CHIV). We assessed the performance of monocyte-lymphocyte ratio (MLR) as a diagnostic biomarker and constructed a clinical prediction score to improve specificity of TB diagnosis in CHIV with limited access to microbiologic testing. METHODS: We pooled data from cohorts of children aged ≤13 years from Vietnam, Cameroon, and South Africa to validate the use of MLR ≥0.378, previously found as a TB diagnostic marker among CHIV. Using multivariable logistic regression, we created an internally validated prediction score for diagnosis of TB disease in CHIV. RESULTS: The combined cohort had 601 children (median age, 1.9 [interquartile range, 0.9-5.3] years); 300 (50%) children were male, and 283 (47%) had HIV. Elevated MLR ≥0.378 had sensitivity of 36% (95% confidence interval [CI], 23%-51%) and specificity of 79% (95% CI, 71%-86%) among CHIV in the validation cohort. A model using MLR ≥0.28, age ≥4 years, tuberculin skin testing ≥5 mm, TB contact history, fever >2 weeks, and chest radiograph suggestive of TB predicted active TB disease in CHIV with an area under the receiver operating characteristic curve of 0.85. A prediction score of ≥5 points had a sensitivity of 94% and specificity of 48% to identify confirmed TB, and a sensitivity of 82% and specificity of 48% to identify confirmed and unconfirmed TB groups combined. CONCLUSIONS: Our score has comparable sensitivity and specificity to algorithms including microbiological testing and should enable clinicians to rapidly initiate TB treatment among CHIV when microbiological testing is unavailable.
dc.language.isoENen_US
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/us/*
dc.subject.enBiomarker
dc.subject.enHIV
dc.subject.enPediatric TB
dc.subject.enPrediction score
dc.subject.enTB diagnosis
dc.title.enDevelopment of a Clinical Prediction Score Including Monocyte-to-Lymphocyte Ratio to Inform Tuberculosis Treatment Among Children With HIV: A Multicountry Study
dc.typeArticle de revueen_US
dc.identifier.doi10.1093/ofid/ofac548en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed36381621en_US
bordeaux.journalOpen Forum Infectious Diseasesen_US
bordeaux.volume9en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue11en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamGHIGS_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03903484
hal.version1
hal.date.transferred2022-12-16T12:55:13Z
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Open%20Forum%20Infectious%20Diseases&rft.date=2022-11&rft.volume=9&rft.issue=11&rft.eissn=2328-8957%20(Print)%202328-8957&rft.issn=2328-8957%20(Print)%202328-8957&rft.au=MALIK,%20Amyn%20A.&GANDHI,%20Neel%20R.&MARCY,%20Olivier&WALTERS,%20Elisabetta&TEJIOKEM,%20Mathurin&rft.genre=article


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