BACKGROUND: The grading of radiological severity in clinical trials in tuberculosis (TB) remains unstandardised. The aim of this study was to generate and validate a numerical score for grading chest x-ray (CXR) severity and predicting response to treatment in adults with smear-positive pulmonary TB. METHODS: At a TB clinic in Papua, Indonesia, serial CXRs were performed at diagnosis, 2 and 6 months in 115 adults with smear-positive pulmonary TB. Radiographic findings predictive of 2-month sputum microscopy status were used to generate a score. The validity of the score was then assessed in a second data set of 139 comparable adults with TB, recruited 4 years later at the same site. Relationships between the CXR score and other measures of TB severity were examined. RESULTS: The estimated proportion of lung affected and presence of cavitation, but not cavity size or other radiological findings, significantly predicted outcome and were combined to derive a score given by percentage of lung affected plus 40 if cavitation was present. As well as predicting 2-month outcome, scores were significantly associated with sputum smear grade at diagnosis (p<0.001), body mass index, lung function, haemoglobin, exercise tolerance and quality of life (p<0.02 for each). In the validation data set, baseline CXR score predicted 2-month smear status significantly more accurately than did the proportion of lung affected alone. In both data sets, CXR scores decreased over time (p<0.001). CONCLUSION: This simple, validated method for grading CXR severity in adults with smear-positive pulmonary TB correlates with baseline clinical and microbiological severity and response to treatment, and is suitable for use in clinical trials.
BACKGROUND: The grading of radiological severity in clinical trials in tuberculosis (TB) remains unstandardised. The aim of this study was to generate and validate a numerical score for grading chest x-ray (CXR) severity and predicting response to treatment in adults with smear-positive pulmonary TB. METHODS: At a TB clinic in Papua, Indonesia, serial CXRs were performed at diagnosis, 2 and 6 months in 115 adults with smear-positive pulmonary TB. Radiographic findings predictive of 2-month sputum microscopy status were used to generate a score. The validity of the score was then assessed in a second data set of 139 comparable adults with TB, recruited 4 years later at the same site. Relationships between the CXR score and other measures of TB severity were examined. RESULTS: The estimated proportion of lung affected and presence of cavitation, but not cavity size or other radiological findings, significantly predicted outcome and were combined to derive a score given by percentage of lung affected plus 40 if cavitation was present. As well as predicting 2-month outcome, scores were significantly associated with sputum smear grade at diagnosis (p<0.001), body mass index, lung function, haemoglobin, exercise tolerance and quality of life (p<0.02 for each). In the validation data set, baseline CXR score predicted 2-month smear status significantly more accurately than did the proportion of lung affected alone. In both data sets, CXR scores decreased over time (p<0.001). CONCLUSION: This simple, validated method for grading CXR severity in adults with smear-positive pulmonary TB correlates with baseline clinical and microbiological severity and response to treatment, and is suitable for use in clinical trials.
Authors: Caian L Vinhaes; Deivide Oliveira-de-Souza; Paulo S Silveira-Mattos; Betania Nogueira; Ruiru Shi; Wang Wei; Xing Yuan; Guolong Zhang; Ying Cai; Clifton E Barry; Laura E Via; Kiyoshi F Fukutani; Bruno B Andrade; Katrin D Mayer-Barber Journal: Cytokine Date: 2019-06-18 Impact factor: 3.861
Authors: N Padayatchi; M Gopal; R Naidoo; L Werner; K Naidoo; I Master; M R O'Donnell Journal: J Antimicrob Chemother Date: 2014-06-30 Impact factor: 5.790
Authors: Ines Labugger; Jan Heyckendorf; Stefan Dees; Emilia Häussinger; Christian Herzmann; Thomas A Kohl; Elvira Richter; Eric Rivera-Milla; Christoph Lange Journal: Infection Date: 2016-10-31 Impact factor: 3.553
Authors: Anna P Ralph; Tsin W Yeo; Cheryl M Salome; Govert Waramori; Gysje J Pontororing; Enny Kenangalem; Emiliana Tjitra; Richard Lumb; Graeme P Maguire; Ric N Price; Mark D Chatfield; Paul M Kelly; Nicholas M Anstey Journal: J Infect Dis Date: 2013-06-03 Impact factor: 5.226
Authors: A Singanayagam; K Manalan; D W Connell; J D Chalmers; S Sridhar; A I Ritchie; A Lalvani; M Wickremasinghe; O M Kon Journal: Int J Tuberc Lung Dis Date: 2016-12 Impact factor: 2.373