Diagnostic Prediction Model for Tuberculous Meningitis: An Individual Participant Data Meta-Analysis

被引：0

作者：

Stadelman-Behar, Anna M. ^{[1
]}

Tiffin, Nicki ^{[2
,3
]}

Ellis, Jayne ^{[4
]}

Creswell, Fiona V. ^{[4
,5
]}

Ssebambulidde, Kenneth ^{[6
]}

Nuwagira, Edwin ^{[7
]}

Richards, Lauren ^{[8
]}

Lutje, Vittoria ^{[9
]}

Hristea, Adriana ^{[10
]}

Jipa, Raluca Elena ^{[10
]}

Vidal, Jose E. ^{[11
,12
,13
]}

Azevedo, Renata G. S. ^{[14
]}

de Almeida, Sergio Monteiro ^{[15
]}

Kussen, Gislene Botao ^{[15
]}

Nogueira, Keite ^{[15
]}

Souza Gualberto, Felipe Augusto ^{[16
]}

Metcalf, Tatiana ^{[17
,18
]}

Heemskerk, Anna Dorothee ^{[19
]}

Dendane, Tarek ^{[20
]}

Khalid, Abidi ^{[20
]}

Zeggwagh, Amine Ali ^{[20
]}

Bateman, Kathleen ^{[21
]}

Siebert, Uwe ^{[22
,23
,24
,25
,26
]}

Rochau, Ursula ^{[26
]}

van Laarhoven, Arjan ^{[27
,28
]}

van Crevel, Reinout ^{[27
,28
]}

Ganiem, Ahmad Rizal ^{[29
,30
]}

Dian, Sofiati ^{[29
,30
]}

Jarvis, Joseph ^{[31
,32
]}

Donovan, Joseph ^{[33
,34
]}

Thuong Nguyen Thuy Thuong ^{[33
,34
]}

Thwaites, Guy E. ^{[33
,34
]}

Bahr, Nathan C. ^{[35
]}

Meya, David B. ^{[36
,37
]}

Boulware, David R. ^{[37
]}

Boyles, Tom H. ^{[32
,38
]}

机构：

[1] Univ Minnesota, Sch Publ Hlth, Minneapolis, MN USA

[2] Univ Western Cape, South African Natl Bioinformat Inst, Cape Town, South Africa

[3] Univ Cape Town, Wellcome CIDRI Africa, Cape Town, South Africa

[4] MRC UVRI LSHTM, Uganda Res Unit, Entebbe, Uganda

[5] Brighton & Sussex Med Sch, Global Hlth & Infect, E Sussex, England

[6] Makerere Univ, Infect Dis Inst, Kampala, Uganda

[7] Mbarara Univ Sci & Technol, Dept Med, Mbarara, Uganda

[8] Univ Witwatersrand, Div Infect Dis, Dept Internal Med, Helen Joseph Hosp, Johannesburg, South Africa

[9] Cochrane Infect Dis Grp, Liverpool, England

[10] Univ Med & Pharm Carol Davila, Bucharest, Romania

[11] Inst Infectol Emilio, Dept Neurol, Sao Paulo, Brazil

[12] Univ Sao Paulo, Div Clin Molestias Infecciosas & Parasitarias, Hosp Clin, Fac Med, Sao Paulo, Brazil

[13] Univ Sao Paulo, Lab Invest Med, Unidad 49, Hosp Clin, Sao Paulo, Brazil

[14] Inst Infectol Emilio, Dept Infectol, Sao Paulo, Brazil

[15] Univ Fed Parana, Hosp Clin, Curitiba, Brazil

[16] AIDS, CRT, DST, Ctr Reference & Training STD, Sao Paulo, Brazil

[17] Mahidol Univ, Dept Clin Trop Med, Fac Trop Med, Bangkok, Thailand

[18] Univ Washington, Northern Pacif Fogarty Global Hlth Fellowship Pro, NIH, Seattle, WA USA

[19] Univ Amsterdam, Dept Med Microbiol & Infect Prevent, Med Ctr, Amsterdam, Netherlands

[20] Mohammed V Univ, Med Intens Care Unit, Ibn Sina Univ Hosp, Rabat, Morocco

[21] Univ Cape Town, Neurol Div, Dept Med, Groote Schuur Hosp, Cape Town, South Africa

[22] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

[23] Harvard TH Chan Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA

[24] Harvard Med Sch, Inst Technol Assessment, Boston, MA USA

[25] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Boston, MA USA

[26] Univ Hlth Sci & Technol, Hall IT, UMIT TIROL, Tyrol, Austria

[27] Radboud Univ Nijmegen, Dept Internal Med, Med Ctr, Nijmegen, Netherlands

[28] Radboud Univ Nijmegen, Radboud Ctr Infect Dis, Med Ctr, Nijmegen, Netherlands

[29] Univ Padjadjaran, Dept Neurol, Hasan Sadikin Hosp, Bandung, Indonesia

[30] Univ Padjadjaran, TB HIV Res Ctr, Fac Med, Bandung, Indonesia

[31] Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana

[32] London Sch Hyg & Trop Med, Dept Clin Res, Fac Infect & Trop Dis, London, England

[33] Univ Oxford, Ctr Trop Med, Clin Res Unit, Ho Chi Minh City, Vietnam

[34] Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Med, Oxford, England

[35] Univ Kansas, Med Ctr, Div Infect Dis, Dept Med, Kansas City, KS USA

[36] Makerere Univ, Dept Med, Fac Hlth Sci, Kampala, Uganda

[37] Univ Minnesota, Div Infect Dis & Int Med, Dept Med, Minneapolis, MN USA

[38] Univ Witwatersrand, Wits Reprod Hlth & HIV Inst, Gauteng, South Africa

来源：

AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE | 2024年 / 111卷 / 03期

基金：

美国国家卫生研究院;

关键词：

XPERT(R) MTB/RIF; VALIDATION; SENSITIVITY; ADULTS; INDEX; SCORE; ASSAY;

D O I：

10.4269/ajtmh.23-0789

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

No accurate and rapid diagnostic test exists for tuberculous meningitis (TBM), leading to delayed diagnosis. We leveraged data from multiple studies to improve the predictive performance of diagnostic models across different populations, settings, and subgroups to develop a new predictive tool for TBM diagnosis. We conducted a systematic review to analyze eligible datasets with individual-level participant data (IPD). We imputed missing data and explored three approaches: stepwise logistic regression, classification and regression tree (CART), and random forest regression. We evaluated performance using calibration plots and C-statistics via internal-external cross-validation. We included 3,761 individual participants from 14 studies and nine countries. A total of 1,240 (33%) participants had "definite" (30%) or "probable" (3%) TBM by case definition. Important predictive variables included cerebrospinal fluid (CSF) glucose, blood glucose, CSF white cell count, CSF differential, cryptococcal antigen, HIV status, and fever presence. Internal validation showed that performance varied considerably between IPD datasets with C-statistic values between 0.60 and 0.89. In external validation, CART performed the worst (C = 0.82), and logistic regression and random forest had the same accuracy (C = 0.91). We developed a mobile app for TBM clinical prediction that accounted for heterogeneity and improved diagnostic performance (https://tbmcalc.github.io/tbmcalc). Further external validation is needed.

引用

页码：546 / 553

页数：8

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