Quantitative IFN-γ Release Assay and Tuberculin Skin Test Results to Predict Incident Tuberculosis. A Prospective Cohort Study.

Gupta, Rishi K, Lipman, Marc, Jackson, Charlotte, Sitch, Alice J, Southern, Jo, Drobniewski, Francis, Deeks, Jonathan J, Tsou, Chuen-Yan, Griffiths, Chris, Davidson, Jennifer, Campbell, Colin, Stirrup, Oliver, Noursadeghi, Mahdad, Kunst, Heinke, Haldar, Pranab, Lalvani, Ajit and Abubakar, Ibrahim (2020) Quantitative IFN-γ Release Assay and Tuberculin Skin Test Results to Predict Incident Tuberculosis. A Prospective Cohort Study. American journal of respiratory and critical care medicine, 201 (8). pp. 984-991. ISSN 1535-4970.

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Official URL: https://www.atsjournals.org/doi/full/10.1164/rccm....

Abstract

Development of diagnostic tools with improved predictive value for tuberculosis (TB) is a global research priority. We evaluated whether implementing higher diagnostic thresholds than currently recommended for QuantiFERON Gold-in-Tube (QFT-GIT), T-SPOT.TB, and the tuberculin skin test (TST) might improve prediction of incident TB. Follow-up of a UK cohort of 9,610 adult TB contacts and recent migrants was extended by relinkage to national TB surveillance records (median follow-up 4.7 yr). Incidence rates and rate ratios, sensitivities, specificities, and predictive values for incident TB were calculated according to ordinal strata for quantitative results of QFT-GIT, T-SPOT.TB, and TST (with adjustment for prior bacillus Calmette-Guérin [BCG] vaccination). For all tests, incidence rates and rate ratios increased with the magnitude of the test result ( < 0.0001). Over 3 years' follow-up, there was a modest increase in positive predictive value with the higher thresholds (3.0% for QFT-GIT ≥0.35 IU/ml vs. 3.6% for ≥4.00 IU/ml; 3.4% for T-SPOT.TB ≥5 spots vs. 5.0% for ≥50 spots; and 3.1% for BCG-adjusted TST ≥5 mm vs. 4.3% for ≥15 mm). As thresholds increased, sensitivity to detect incident TB waned for all tests (61.0% for QFT-GIT ≥0.35 IU/ml vs. 23.2% for ≥4.00 IU/ml; 65.4% for T-SPOT.TB ≥5 spots vs. 27.2% for ≥50 spots; 69.7% for BCG-adjusted TST ≥5 mm vs. 28.1% for ≥15 mm). Implementation of higher thresholds for QFT-GIT, T-SPOT.TB, and TST modestly increases positive predictive value for incident TB, but markedly reduces sensitivity. Novel biomarkers or validated multivariable risk algorithms are required to improve prediction of incident TB.

Item Type: Article
Subjects: WF Respiratory system. Respiratory medicine
Divisions: Planned IP Care > Respiratory Medicine
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Depositing User: Beth Connors
Date Deposited: 08 Jul 2020 10:04
Last Modified: 08 Jul 2020 10:04
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3231

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