Discovery and validation of a personalized risk predictor for incident tuberculosis in low transmission settings
Por:
Gupta, RK, Calderwood, CJ, Yavlinsky, A, Krutikov, M, Quartagno, M, Aichelburg, MC, Altet, N, Diel, R, Dobler, CC, Dominguez, J, Doyle, JS, Erkens, C, Geis, S, Haldar, P, Hauri, AM, Hermansen, T, Johnston, JC, Lange, C, Lange, B, van Leth, F, Munoz, L, Roder, C, Romanowski, K, Roth, D, Sester, M, Sloot, R, Sotgiu, G, Woltmann, G, Yoshiyama, T, Zellweger, JP, Zenner, D, Aldridge, RW, Copas, A, Rangaka, MX, Lipman, M, Noursadeghi, M and Abubakar, I
Publicada:
1 dic 2020
Ahead of Print:
1 oct 2020
Resumen:
The risk of tuberculosis (TB) is variable among individuals with latentMycobacterium tuberculosisinfection (LTBI), but validated estimates of personalized risk are lacking. In pooled data from 18 systematically identified cohort studies from 20 countries, including 80,468 individuals tested for LTBI, 5-year cumulative incident TB risk among people with untreated LTBI was 15.6% (95% confidence interval (CI), 8.0-29.2%) among child contacts, 4.8% (95% CI, 3.0-7.7%) among adult contacts, 5.0% (95% CI, 1.6-14.5%) among migrants and 4.8% (95% CI, 1.5-14.3%) among immunocompromised groups. We confirmed highly variable estimates within risk groups, necessitating an individualized approach to risk stratification. Therefore, we developed a personalized risk predictor for incident TB (PERISKOPE-TB) that combines a quantitative measure of T cell sensitization and clinical covariates. Internal-external cross-validation of the model demonstrated a random effects meta-analysis C-statistic of 0.88 (95% CI, 0.82-0.93) for incident TB. In decision curve analysis, the model demonstrated clinical utility for targeting preventative treatment, compared to treating all, or no, people with LTBI. We challenge the current crude approach to TB risk estimation among people with LTBI in favor of our evidence-based and patient-centered method, in settings aiming for pre-elimination worldwide.
The risk of developing active tuberculosis (TB) in individuals with latent TB infection is highly variable within and among different risk groups. A personalized risk predictor was developed to better target preventative treatment to individuals at greatest risk, supporting evidence-based clinical decision-making for latent TB.
Filiaciones:
Gupta, RK:
UCL, Inst Global Hlth, London, England
Calderwood, CJ:
UCL, Inst Global Hlth, London, England
Yavlinsky, A:
UCL, Inst Hlth Informat, London, England
Krutikov, M:
UCL, Inst Global Hlth, London, England
Quartagno, M:
UCL, Inst Clin Trials & Methodol, MRC Clin Trials Unit, London, England
Aichelburg, MC:
Donauspital, Dept Dermatol, Sozialmed Zentrum Ost, Vienna, Austria
Altet, N:
Hosp Univ Vall dHebron Drassanes, Unitat TB, Barcelona, Spain
Unitat TDO TB Serv Clin, Barcelona, Spain
Diel, R:
Univ Hosp Schleswig Holstein, Inst Epidemiol, Campus Kiel, Kiel, Germany
Airway Res Ctr North ARCN, Lung Clin Grosshansdorf, Grosshansdorf, Germany
Dobler, CC:
Bond Univ, Inst Evidence Based Healthcare, Fac Hlth Sci & Med, Gold Coast, Qld, Australia
Liverpool Hosp, Dept Resp Med, Sydney, NSW, Australia
:
Inst Invest Germans Trias & Pujol, Barcelona, Spain
CIBER Enfermedades Resp, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Doyle, JS:
Alfred & Monash Univ, Dept Infect Dis, Melbourne, Vic, Australia
Burnet Inst, Dis Eliminat Program, Melbourne, Vic, Australia
Erkens, C:
KNCV TB Fdn, The Hague, Netherlands
Geis, S:
Philipps Univ Marburg, Inst Med Microbiol & Hosp Hyg, Marburg, Germany
Haldar, P:
Univ Leicester, Inst Lung Hlth, Dept Resp Sci, Resp Biomed Res Ctr, Leicester, Leics, England
Hauri, AM:
Hesse State Hlth Off, Dillenburg, Germany
Hermansen, T:
Statens Serum Inst, Int Reference Lab Mycobacteriol, Copenhagen, Denmark
Johnston, JC:
British Columbia Ctr Dis Control, Vancouver, BC, Canada
Lange, C:
Res Ctr Borstel, Div Clin Infect Dis, Borstel, Germany
German Ctr Infect Res DZIF, Clin TB Ctr, Borstel, Germany
TB Network European Trials Grp TBnet, Borstel, Germany
Karolinska Inst, Dept Med, Stockholm, Sweden
Lange, B:
Helmholtz Ctr Infect Res, Dept Epidemiol, Braunschweig, Germany
van Leth, F:
TB Network European Trials Grp TBnet, Borstel, Germany
Amsterdam Inst Global Hlth & Dev, Amsterdam, Netherlands
Univ Amsterdam, Dept Global Hlth, Med Ctr, Amsterdam, Netherlands
Munoz, L:
Univ Barcelona, Dept Clin Sci, Barcelona, Spain
Roder, C:
Alfred & Monash Univ, Dept Infect Dis, Melbourne, Vic, Australia
Burnet Inst, Dis Eliminat Program, Melbourne, Vic, Australia
Romanowski, K:
British Columbia Ctr Dis Control, Vancouver, BC, Canada
Roth, D:
British Columbia Ctr Dis Control, Vancouver, BC, Canada
Sester, M:
TB Network European Trials Grp TBnet, Borstel, Germany
Saarland Univ, Dept Transplant & Infect Immunol, Homburg, Germany
Sloot, R:
Stellenbosch Univ, Desmond Tutu TB Ctr, Dept Paediat & Child Hlth, Fac Med & Hlth Sci, Cape Town, South Africa
Sotgiu, G:
TB Network European Trials Grp TBnet, Borstel, Germany
Uniivers Sassari, Dept Med Surg & Expt Sci, Clin Epidemiol & Med Stat Unit, Sassari, Italy
Woltmann, G:
Univ Leicester, Inst Lung Hlth, Dept Resp Sci, Resp Biomed Res Ctr, Leicester, Leics, England
Yoshiyama, T:
Res Inst TB, Tokyo, Japan
Zellweger, JP:
TB Network European Trials Grp TBnet, Borstel, Germany
Swiss Lung Assoc, Bern, Switzerland
Zenner, D:
UCL, Inst Global Hlth, London, England
Aldridge, RW:
UCL, Inst Hlth Informat, London, England
Copas, A:
Univ Autonoma Barcelona, Barcelona, Spain
Rangaka, MX:
UCL, Inst Global Hlth, London, England
UCL, Inst Clin Trials & Methodol, MRC Clin Trials Unit, London, England
Univ Cape Town, Inst Infect Dis & Mol Med, Wellcome Ctr Infect Dis Res Africa, Cape Town, South Africa
Univ Cape Town, Sch Publ Hlth, Div Epidemiol & Biostat, Cape Town, South Africa
Lipman, M:
UCL, UCL TB & UCL Resp, London, England
Royal Free London NHS Fdn Trust, London, England
Noursadeghi, M:
UCL, Div Infect & Immun, London, England
Abubakar, I:
UCL, Inst Global Hlth, London, England
Green Submitted
|