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@article{Whitworth:2019:10.1016/S1473-3099(18)30613-3,
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, FA and Wiselka, M and Woltmann, G and Deeks, JJ and Kon, OM and Lalvani, A and Interferon-, Release Assays for Diagnostic Evaluation of Active Tuberculosis study group},
doi = {10.1016/S1473-3099(18)30613-3},
journal = {Lancet Infectious Diseases},
pages = {193--202},
title = {Clinical utility of existing and second-generation interferon-γ release assays for diagnostic evaluation of tuberculosis: an observational cohort study},
url = {http://dx.doi.org/10.1016/S1473-3099(18)30613-3},
volume = {19},
year = {2019}
}

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TY  - JOUR
AB  - BACKGROUND: The clinical utility of interferon-γ release assays (IGRAs) for diagnosis of active tuberculosis is unclear, although they are commonly used in countries with a low incidence of tuberculosis. We aimed to resolve this clinical uncertainty by determining the accuracy and utility of commercially available and second-generation IGRAs in the diagnostic assessment of suspected tuberculosis in a low-incidence setting. METHODS: We did a prospective cohort study of adults with suspected tuberculosis in routine secondary care in England. Patients were tested for Mycobacterium tuberculosis infection at baseline with commercially available (T-SPOT.TB and QuantiFERON-TB Gold In-Tube [QFT-GIT]) and second-generation (incorporating novel M tuberculosis antigens) IGRAs and followed up for 6-12 months to establish definitive diagnoses. Sensitivity, specificity, positive and negative likelihood ratios, and predictive values of the tests were determined. FINDINGS: Of the 1060 adults enrolled in the study, 845 were eligible and 363 were diagnosed with tuberculosis. Sensitivity of T-SPOT.TB for all tuberculosis diagnosis was 81·4% (95% CI 76·6-85·3), which was higher than QFT-GIT (67·3% [62·0-72·1]). Second-generation IGRAs had a sensitivity of 94·0% (90·0-96·4) for culture-confirmed tuberculosis and 89·2% (85·2-92·2) when including highly probable tuberculosis, giving a negative likelihood ratio for all tuberculosis cases 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% (75·6-83·8) for second-generation IGRAs. INTERPRETATION: Commercially available IGRAs do not have sufficient accuracy for diagnostic evaluation of suspected tuberculosis. Second-generation tests, however, might have sufficiently high sensitivity, low negative likelihood ratio, and correspondingly high negati
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,FA
AU  - Wiselka,M
AU  - Woltmann,G
AU  - Deeks,JJ
AU  - Kon,OM
AU  - Lalvani,A
AU  - Interferon-,Release Assays for Diagnostic Evaluation of Active Tuberculosis study group
DO  - 10.1016/S1473-3099(18)30613-3
EP  - 202
PY  - 2019///
SN  - 1473-3099
SP  - 193
TI  - Clinical utility of existing and second-generation interferon-γ release assays for diagnostic evaluation of tuberculosis: an observational cohort study
T2  - Lancet Infectious Diseases
UR  - http://dx.doi.org/10.1016/S1473-3099(18)30613-3
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30655049
UR  - https://www.sciencedirect.com/science/article/pii/S1473309918306133?via%3Dihub
UR  - http://hdl.handle.net/10044/1/66146
VL  - 19
ER  -

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PROFESSOR AJIT LALVANI

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