scholarly journals Use  of T-SPOT.TB for the diagnosis of unconventional pleural tuberculosis is superior to ADA in high prevalence areas: A prospective analysis of 601 cases

2020 ◽  
Author(s):  
Xinting Yang ◽  
jing zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  

Abstract BACKGROUND: Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation which still has lasting effect on lung function, however conventional diagnostic tests for TPE register multiple limitations. OBJECTIVES: This study aims to investigate diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics comparing to adenosine deaminase (ADA), in order to clarify its appropriate setting in clinical diagnosis.METHODS: We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. By using receiver operating characteristic (ROC) curves, technical cut-offs for all enrolled participants were determined, and the utility of IGRA for pleural fluid (PF) was analysed. We obtained the independent risk factors using logistic regression analysis for TPE and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA.RESULTS: A total of 601 individuals was consecutively recruited. The maximum of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, with a sensitivity of 83.0% and a specificity of 83.1%. The corresponding cut-off value was 466 SFCs/106 mononuclear cells, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior to PB. Among the TPE patients with low ADA (<40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9% and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (<45 yrs; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59-8.78; P<0.001), gender (male; OR = 2.68, 95% CI 1.75-2.88; P<0.001) and body mass index (BMI) (<22; OR = 1.93, 95% CI 1.30-2.88; P=0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity (76.5% vs. 23.5%, P=0.016) for ADA and had noninferior specificity (84.4% vs. 96.9%, P=0.370).CONCLUSIONS: In conclusion, the overall potency of the PF T-SPOT assay is equal to that of ADA for diagnosing TPE. In addition, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is extremely superior to ADA in unconventional TPE patients (age≥45 yrs, female or BMI≥22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.

2020 ◽  
Author(s):  
Xinting Yang ◽  
jing zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  

Abstract BACKGROUND: Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics.METHODS: We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA.RESULTS: A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (<40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9% and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (<45 yrs; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59-8.78; P<0.001), gender (male; OR = 2.68, 95% CI 1.75-2.88; P<0.001) and body mass index (BMI) (<22; OR = 1.93, 95% CI 1.30-2.88; P=0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P=0.016) and had noninferior specificity (84.4% vs. 96.9%, P=0.370).CONCLUSIONS: In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age≥45 yrs, female or BMI≥22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xinting Yang ◽  
Jing Zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  

Abstract Background Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics. Methods We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA. Results A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P = 0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (< 40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9 and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (< 45 yrs.; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59–8.78; P < 0.001), gender (male; OR = 2.68, 95% CI 1.75–2.88; P < 0.001) and body mass index (BMI) (< 22; OR = 1.93, 95% CI 1.30–2.88; P = 0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P = 0.016) and had noninferior specificity (84.4% vs. 96.9%, P = 0.370). Conclusions In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age ≥ 45 yrs., female or BMI ≥ 22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.


2020 ◽  
Author(s):  
Xinting Yang ◽  
Jing Zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  

Abstract BACKGROUND: Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. however conventional diagnostic tests for TPE register multiple limitations. OBJECTIVES: To investigate diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics.METHODS: We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. By using receiver operating characteristic (ROC) curves, technical cut-offs for all enrolled participants were determined, and the utility of T-SPOT on pleural fluid (PF) was analysed. We obtained the independent risk factors using logistic regression analysis for TPE and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA.RESULTS: A total of 601 individuals was consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior to PB, with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (<40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9% and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (<45 yrs; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59-8.78; P<0.001), gender (male; OR = 2.68, 95% CI 1.75-2.88; P<0.001) and body mass index (BMI) (<22; OR = 1.93, 95% CI 1.30-2.88; P=0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity (76.5% vs. 23.5%, P=0.016) for ADA and had noninferior specificity (84.4% vs. 96.9%, P=0.370).CONCLUSIONS: In conclusion, the overall potency of the PF T-SPOT assay is equal to that of ADA for diagnosing TPE. In addition, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is extremely superior to ADA in unconventional TPE patients (age≥45 yrs, female or BMI≥22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.


2020 ◽  
Author(s):  
Xinting Yang ◽  
jing zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  

Abstract BACKGROUND Recently, Interferon Gamma Release Assay (IGRA) is still controversial in differentiating tuberculous pleural effusion (TPE), through recommended by World Health Organization (WHO )for identification of latent tuberculosis infection. OBJECTIVES Aim to qualify the diagnostic efficacy for TPE by IGRA in comparison to Adenosine deaminase(ADA), to clarify its appropriate scene in clinical diagnosis. METHODS A prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, all enrolled participants were determined technical cut-off and the utility of IGRA(T-SPOT)for pleural fluid(PF). Obtain the independent risk factors by logistic regression analysis for TPE, and evaluate the performance of T-SPOT stratified by risk factors, in comparison to ADA. RESULTS A total of 601 individuals were consecutively recruited. The maximum of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in PF T-SPOT had the best diagnostic efficiency in our study, with a sensitivity of 83.0% and a specificity of 83.1%, corresponding cut-off value is 466, which was equal to ADA(0.885 vs 0.887, P=0.957) and superior than in PB; Among the TPE patients with low ADA(<40 IU/L), the sensitivity and specificity of PF T-SPOT was still 87.9%, 90.5% respectively. The utility of ADA was negative related to age ascents, but PF T-SPOT had steady performance at any age-stage. The age (<45 yrs; odds ratio (OR) 5.61), gender (male; OR 2.7) and body mass index (BMI)(<22; OR 1.93) was independently associated with the risk of TB by multivariate logistic regression analysis. Stratified by risk factors, notably the PF T-SPOT had superior sensitivity(76.5% vs. 23.5%,P=0.016) than ADA meanwhile had the non-inferior specificity(84.4% vs. 96.9%, P=0.370). CONCLUSIONS In conclusion, the overall potency of PF T-SPOT assay is equal to ADA for diagnosing TPE. In addition, PF T-SPOT can effectively discriminate the TPE patients whose ADA lower than 40IU/L, and extremely superior to ADA in unconventional TPE patients(age>45yrs, female or BMI<22). PF T-SPOT assay is an extremely good choice to supplement ADA to diagnose TPE.


2020 ◽  
Author(s):  
Xinting Yang ◽  
jing zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  

Abstract BACKGROUND: Interferon Gamma Release Assay (IGRA) is still controversial in differentiating tuberculous pleural effusion (TPE), through recommended by World Health Organization (WHO) for identification of latent tuberculosis infection. OBJECTIVES: Aim to in comparison to Adenosine deaminase (ADA), evaluate the IGRA (T-SPOT.TB) diagnostic efficacy for TPE patients of different characteristics, to clarify its appropriate scene in clinical diagnosis. METHODS: A prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, all enrolled participants were determined technical cut-off and the utility of IGRA for pleural fluid (PF). Obtain the independent risk factors by logistic regression analysis for TPE, and evaluate the performance of T-SPOT stratified by risk factors, in comparison to ADA. RESULTS: A total of 601 individuals were consecutively recruited. The maximum of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in PF T-SPOT had the best diagnostic efficiency in our study, with a sensitivity of 83.0% and a specificity of 83.1%, corresponding cut-off value is 466 SFCs/10 6 mononuclear cells, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior than in PB; Among the TPE patients with low ADA(<40 IU/L), the sensitivity and specificity of PF T-SPOT was still 87.9%, 90.5% respectively. The utility of ADA was negative related to age ascents, but PF T-SPOT had steady performance at any age-stage. The age (<45 yrs; odds ratio (OR) = 5.61), gender (male; OR = 2.7) and body mass index (BMI) (<22; OR = 1.93) was independently associated with the risk of TB by multivariate logistic regression analysis. Stratified by risk factors, notably the PF T-SPOT had superior sensitivity (76.5% vs. 23.5%, P =0.016) than ADA meanwhile had the non-inferior specificity (84.4% vs. 96.9%, P =0.370). CONCLUSIONS: In conclusion, the overall potency of PF T-SPOT assay is equal to ADA for diagnosing TPE. In addition, PF T-SPOT can effectively discriminate the TPE patients whose ADA lower than 40 IU/L, extremely superior to ADA in unconventional TPE patients (age>45yrs, female or BMI≧22). PF T-SPOT assay is an extremely good choice to supplement ADA to diagnose TPE.


2020 ◽  
Vol 8 ◽  
Author(s):  
Chen Dong ◽  
Minhui Zhu ◽  
Luguang Huang ◽  
Wei Liu ◽  
Hengxin Liu ◽  
...  

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p &lt; 0.001), larger volume of expander (200–400 ml vs &lt;200 ml; OR, 1.74; p = 0.032; &gt;400 ml vs &lt;200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of &lt;1 year, expander volume of &gt;200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.


Author(s):  
Elisabetta Schiaroli ◽  
Anna Gidari ◽  
Giovanni Brachelente ◽  
Sabrina Bastianelli ◽  
Alfredo Villa ◽  
...  

IntroductionCOVID-19 is characterized by a wide range of clinical expression and by possible progression to critical illness and death. Therefore it is essential to identify risk factors predicting progression towards serious and fatal diseases. The aim of our study was to identify laboratory predictive markers of clinical progression in patients with moderate/severe disease and in those with acute respiratory distress syndrome (ARDS).Material and methodsUsing electronic medical records for all demographic, clinical and laboratory data, a retrospective study on all consecutive patients with COVID-19 admitted to the Infectious Disease Clinic of Perugia was performed. The PaO2/FiO2 ratio (P/F) assessment cut‑off of 200 mm Hg was used at baseline to categorize the patients into two clinical groups. The progression towards invasive ventilation and/or death was used to identify critical outcome. Statistical analysis was performed. Multivariate logistic regression analysis was adopted to identify risk factors of critical illness and mortality.ResultsIn multivariate logistic regression analysis neutrophil/lymphocyte ratio (NLR) was the only significant predictive factor of progression to a critical outcome (p = 0.03) and of in-hospital mortality (p = 0.03). In ARDS patients no factors were associated with critical progression. Serum ferritin > 1006 ng/ml was the only predictive value of critical outcome in COVID-19 subjects with moderate/severe disease (p = 0.02).ConclusionsNeutrophil/lymphocyte ratio and serum ferritin are the only biomarkers that can help to stratify the risk of severity and mortality in patients with COVID-19.


2021 ◽  
Vol 8 ◽  
Author(s):  
Xiya Lu ◽  
Zhijing Wang ◽  
Liu Yang ◽  
Changqing Yang ◽  
Meiyi Song

Background and Objectives: Liver cirrhosis is known to be associated with atrial arrhythmia. However, the risk factors for atrial arrhythmia in patients with liver cirrhosis remain unclear. This retrospective study aimed to investigate the risk factors for atrial arrhythmia in patients with liver cirrhosis.Methods: In the present study, we collected data from 135 patients with liver cirrhosis who were admitted to the Department of Gastroenterology at Shanghai Tongji Hospital. We examined the clinical information recorded, with the aim of identifying the risk factors for atrial arrhythmia in patients with liver cirrhosis. Multiple logistic regression analysis was used to screen for significant factors differentiating liver cirrhosis patients with atrial arrhythmia from those without atrial arrhythmia.Results: The data showed that there were seven significantly different factors that distinguished the group with atrial arrhythmia from the group without atrial arrhythmia. The seven factors were age, white blood cell count (WBC), albumin (ALB), serum Na+, B-type natriuretic peptide (BNP), ascites, and Child-Pugh score. The results of multivariate logistic regression analysis suggested that age (β = 0.094, OR = 1.098, 95% CI 1.039–1.161, P = 0.001) and ascites (β =1.354, OR = 3.874, 95% CI 1.202–12.483, P = 0.023) were significantly associated with atrial arrhythmia.Conclusion: In the present study, age and ascites were confirmed to be risk factors associated with atrial arrhythmia in patients with liver cirrhosis.


2019 ◽  
Vol 76 (11) ◽  
pp. 1178-1183 ◽  
Author(s):  
Admir Sabanovic ◽  
Natasa Maksimovic ◽  
Mirjana Stojanovic-Tasic ◽  
Marijan Bakic ◽  
Anita Grgurevic

Background/Aim. The assessment of association of depression and diabetes mellitus type 2 using the Patient Health Questionaire (PHQ-9) has not been done in Montenegro. The aim of this study was to assess the prevalence of depression in the patients with type 2 diabetes mellitus, and to identify the risk factors associated with the presence of depression. Methods. A cross-sectional study was conducted at the General Hospital in Bijelo Polje, from July to September, 2015. It included 70 patients over 35 years of age with the diagnosis of diabetes for at least six months. For the assessment of depression presence and intensity PHQ?9 was used. All variables associated with the presence of depression at a significance level of p < 0.05 were included into the final method of the multivariate logistic regression analysis. Results. Comorbidities were statistically significant more frequent among patients with depression (?2 = 5.40; p = 0.020). Duration of diabetes over five years was significantly associated with depression (?2 = 12.48; p < 0.001). Depression occurred more frequently among physically inactive subjects (?2 = 10.74; p = 0.005). The presence of diabetic polyneuropathy (?2 = 6.04; p = 0.014) and cataract (?2 = 5.351; p = 0.021) were also significantly associated with depression. A multivariate logistic regression analysis showed that the duration of diabetes over five years and presence of cataract were independently associated with depression. Conclusion. The risk factors for depression among the subjects with diabetes were disease duration more than five years and the presence of cataract. Since depression is a serious disease and can be a risk factor for many chronic diseases, the best way of prevention is its early detection and treatment.


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