Imperial College London
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PROFESSOR AJIT LALVANI

Faculty of Medicine, National Heart & Lung Institute

Chair in Infectious Diseases
 
 
 
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Contact

 

+44 (0)20 7594 0883a.lalvani

 
 
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Assistant

 

Dr Luis Berrocal Almanza +44 (0)20 7594 3721

 
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Location

 

Medical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Whitworth,
author = {Whitworth, HS and Badhan, A and Boakye, AA and Takwoingi, Y and Rees-Roberts, M and Partlett, C and Lambie, H and Innes, J and Cooke, G and Lipman, M and Conlon, C and Macallan, D and Chua, F and Post, F and Wiselka, M and Woltmann, G and Deeks, JJ and Kon, OM and Lalvani, A and Diagnostic, Evaluation of Active TB IDEA Study Group},
journal = {Lancet Infectious Diseases},
title = {An observational cohort study to evaluate the clinical utilty of current and second-generation interferon-gamma release-assays in diagnostic evaluation of tuberculosis},
url = {http://hdl.handle.net/10044/1/65230},
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundThe role of interferon-gamma release assays (IGRAs) in diagnosis of active tuberculosis (TB) is unclear, yet they are commonly used in low-TB-incidence countries. This study sought to resolve this clinical uncertainty by determining the diagnostic accuracy and role of current and second-generation IGRAs in the diagnostic assessment of suspected TB in a low-incidence setting. MethodsThis was a prospective cohort study of 1,060 adults with suspected TB, conducted in routine secondary care in England. Patients were tested for M. tuberculosis (Mtb) infection at baseline using current and second-generation IGRAs, the latter incorporating novel Mtb antigens, and followed up for 6-12m to establish definitive diagnoses. Sensitivity, specificity and positive and negative likelihood ratios (LRs) and predictive values (PVs) of the tests for TB were determined.FindingsTB was diagnosed in 363 (43%) of 845 patients included in analyses. Sensitivity of T-SPOT.TB was 81.4% (95%CI 76.6-85.3%), higher than Quantiferon-Gold In-Tube at 67.3% (95%CI 62.0-72.1%). Second-generation IGRA had higher sensitivity than current tests, at 94.0% (95%CI 90.0–96.4%) for culture-confirmed TB and 89.2% (95%CI 85.2–92.2%) when including highly-probable TB, giving a negative LR for all TB of 0.13 (95%CI 0.10-0.19). Specificity ranged from 86.2% (95%CI 82.3-89.4%) for T-SPOT.TB to 80.0% (95%CI 75.6-83.8%) for second-generation IGRA.InterpretationCurrently-available IGRAs lack sufficient accuracy for diagnostic evaluation of suspected TB. Second-generation tests, however, may have sufficiently high sensitivity, low negative LR and correspondingly high negative PV in low-incidence settings to facilitate prompt rule-out of TB.
AU  - Whitworth,HS
AU  - Badhan,A
AU  - Boakye,AA
AU  - Takwoingi,Y
AU  - Rees-Roberts,M
AU  - Partlett,C
AU  - Lambie,H
AU  - Innes,J
AU  - Cooke,G
AU  - Lipman,M
AU  - Conlon,C
AU  - Macallan,D
AU  - Chua,F
AU  - Post,F
AU  - Wiselka,M
AU  - Woltmann,G
AU  - Deeks,JJ
AU  - Kon,OM
AU  - Lalvani,A
AU  - Diagnostic,Evaluation of Active TB IDEA Study Group
SN  - 1473-3099
TI  - An observational cohort study to evaluate the clinical utilty of current and second-generation interferon-gamma release-assays in diagnostic evaluation of tuberculosis
T2  - Lancet Infectious Diseases
UR  - http://hdl.handle.net/10044/1/65230
ER  -
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