免疫抑制患者 QuantiFERON-TB Gold Plus® 不确定结果的回归预测模型。

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL SAGE Open Medicine Pub Date : 2024-09-09 eCollection Date: 2024-01-01 DOI:10.1177/20503121241279116
Rahma Bellagha, Tarak Dhaouadi, Awatef Riahi, Wahiba Ben Rehouma, Hajer Jedidi, Leila Mouelhi, Leila Abdelmoula, Taïeb Ben Abdallah, Yousr Gorgi, Imen Sfar
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引用次数: 0

摘要

背景:在开始抗肿瘤坏死因子(TNF)生物疗法或免疫抑制疗法之前,使用干扰素-γ释放测定法筛查潜伏结核感染是一项常规程序。目的:本横断面研究旨在估计突尼斯患者中定量FERON-TB Gold Plus®检测结果不确定的频率,并分析与这些不确定结果相关的潜在临床生物风险因素:采用 QuantiFERON-TB Gold Plus® 检测法对 712 名接受自身免疫性疾病监测的患者和抗肿瘤坏死因子生物疗法或免疫抑制疗法转换的候选者的全血样本进行潜伏结核感染筛查。根据文献背景,检测了以下变量与不确定结果的相关性:性别、年龄、糖尿病、免疫抑制剂、淋巴细胞计数、中性粒细胞与淋巴细胞比率、血清白蛋白和估计肾小球滤过率:572例(80.3%)患者的QuantiFERON-TB Gold Plus®检测结果为阴性,106例(14.9%)为阳性,34例(4.8%)为不确定。阳性结果与确诊和治疗过肺结核的家族史明显相关,OR (95% CI) = 52 (20.2-134.3)。使用免疫抑制剂和治疗持续时间与出现不确定结果有明显关系:OR (95% CI) = 24.5 (5.8-103) 和 OR (95% CI) = 1.004 (1.002-1.007)。从生物学角度看,淋巴细胞减少症、低白蛋白血症和估计肾小球滤过率降低是导致结果不确定的重要风险因素:分别为 p = 5 E-6、p = 4.3 E-4 和 p = 0.002。因此,基于这三个生物学参数的多元逻辑回归模型使我们能够建立一个预测不确定结果的评分,其灵敏度为 91.2%,特异性为 99.9%,AUC = 0.9964 (0.9917-1),p = 2.8 E-52:免疫抑制疗法、淋巴细胞减少症、低白蛋白血症和肾衰竭似乎是导致定量FERON-TB Gold Plus®检测结果不确定的风险因素。
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A regression predictive model for QuantiFERON-TB Gold Plus® indeterminate results in immunosuppressed patients.

Background: Screening for latent tuberculosis infection using Interferon-Gamma Release Assays is a routine procedure prior to the initiation of anti-tumor necrosis factor (TNF) biotherapy or immunosuppressive therapy. However, indeterminate results are relatively frequent and are an obstacle to treatment initiation.

Aim: The aim of this cross-sectional study was to estimate the frequency of indeterminate QuantiFERON-TB Gold Plus® test results in Tunisian patients, and to analyze the potential clinico-biological risk factors associated with these indeterminate results.

Methods: Whole blood samples from 712 patients being monitored for autoimmune diseases and candidates for anti-TNF biotherapy or switch of immunosuppressive therapy were used to screen for latent tuberculosis infection using the QuantiFERON-TB Gold Plus® test. Based on literature background, the following variables were tested for the association with indeterminate results: gender, age, diabetes, immunosuppressive drugs, lymphocyte count, Neutrophil-to-lymphocyte ratio, serum albumin, and estimated glomerular filtration rate.

Results: The QuantiFERON-TB Gold Plus® test was negative in 572 (80.3%) patients, positive in 106 (14.9%), and indeterminate in 34 (4.8%) cases. Positive results were significantly associated with a family history of confirmed and treated tuberculosis, OR (95% CI) = 52 (20.2-134.3). The use of immunosuppressive drugs and duration of treatment were significantly associated with the occurrence of indeterminate results: OR (95% CI) = 24.5 (5.8-103) and OR (95% CI) = 1.004 (1.002-1.007), respectively. Biologically, lymphopenia, hypoalbuminemia, and decreased estimated glomerular filtration rate were significant risk factors for indeterminate results: p = 5 E-6, p = 4.3 E-4, and p = 0.002, respectively. Thus, a multiple logistic regression model based on these three biological parameters enabled us to develop a predictive score for indeterminate results with a sensitivity of 91.2% and a specificity of 99.9%, AUC = 0.9964 (0.9917-1), p = 2.8 E-52.

Conclusion: Immunosuppressive therapy, lymphopenia, hypoalbuminemia, and kidney failure appeared to be risk factors for indeterminate QuantiFERON-TB Gold Plus® results.

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来源期刊
SAGE Open Medicine
SAGE Open Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.50
自引率
4.30%
发文量
289
审稿时长
12 weeks
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