Kriel M., Lotz J.W., Kidd M., Walzl G.
Department of Science and Technology, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, PO Box 19063, Tygerberg, Cape Town, South Africa; Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Cape Town, South Africa; Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa
Kriel, M., Department of Science and Technology, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, PO Box 19063, Tygerberg, Cape Town, South Africa; Lotz, J.W., Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Cape Town, South Africa; Kidd, M., Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa; Walzl, G., Department of Science and Technology, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, PO Box 19063, Tygerberg, Cape Town, South Africa
OBJECTIVE : To refine and evaluate a recently published radiological disease severity score for the prediction of month 2 and end of treatment outcomes in pulmonary tuberculosis (TB). Radiological extent of disease has been linked to early and late outcomes of antituberculosis treatment, but no validated tools are available to quantify this parameter. DESIGN: We enrolled 449 adult, human immunodeficiency virus negative participants with smear- or cultureproven TB from three TB biomarker studies in Cape Town, South Africa. Full-size posteroanterior baseline chest X-rays (CXRs) were evaluated by two clinicians after standardising the published scoring method and the predictive ability assessed for month 2 and final treatment outcomes. RESULT S : Baseline CXR scores were significantly different in the favourable and unfavourable outcome groups; however, the predictive ability for outcomes at all time points was poor (ROC area under curve≤0.68). Inter-reader reliability was high (r = 0.86, P < 0.001), but agreement in cavity identification was modest. CONC LUS ION: Standardised application of a CXR score derived from the presence of cavities and overall extent of parenchymal disease in active TB showed good inter- and intrareader reliability. Scores differed significantly in treatment outcome groups, but did not allow accurate outcome prediction. © 2015 The Union.
isoniazid; tuberculostatic agent; adult; Article; controlled study; disease severity; female; human; image analysis; interrater reliability; lung parenchyma; lung tuberculosis; major clinical study; male; multidrug resistance; outcome assessment; priority journal; prognosis; receiver operating characteristic; scoring system; South Africa; sputum culture; sputum smear; standardization; thorax radiography; treatment duration