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Factors Associated with Indeterminate and False Negative Results of QuantiFERON-TB Gold In-Tube Test in Active Tuberculosis.

Cho K, Cho E, Kwon S, Im S, Sohn I, Song S, Kim H, Kim S - Tuberc Respir Dis (Seoul) (2012)

Bottom Line: Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay, lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels.In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32).Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.

ABSTRACT

Background: The sensitivities and specificities of interferon-gamma release assays (IGRAs) vary among different population studies, and the data on the routine use of IGRAs are limited. The aim of this study was to evaluate the role of QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of active tuberculosis.

Methods: We conducted a prospective study, enrolling 77 patients with suspected pulmonary tuberculosis (TB), at a secondary care teaching hospital in Seoul.

Results: In total, 12 (15.6%) patients showed indeterminate results due to positive control failure on the QFT-GIT test. Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay, lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels. Of the 77 patients, 44 (57.1%) were diagnosed with active pulmonary tuberculosis, and the percentage of false negative results of the QFT-GIT was 36.4% (vs. 31.8% with TST). In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32).

Conclusion: Indeterminate and false negative results of QFT-GIT test were not infrequent in tuberculosis, especially in the elderly. Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients.

No MeSH data available.


Related in: MedlinePlus

The proportion of determinate and indeterminate QFT-GIT results in each age group. QFT-GIT: Quanti-FERON-TB Gold In-Tube.
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Figure 1: The proportion of determinate and indeterminate QFT-GIT results in each age group. QFT-GIT: Quanti-FERON-TB Gold In-Tube.

Mentions: The median age of the indeterminate group was shown to be 70.5 years (IQR, 55.5~76.0), which was significantly higher than that of the determinate group (51.0, IQR 41~66.0) (p=0.011). The age distribution of patients showing indeterminate results on QFT-GIT test is shown in Figure 1. Indeterminate results were significantly more frequent among the age bracket of 65 years or higher (25.0% with indeterminate results vs. 18.4% with determinate results) and age bracket of 75 years or higher (33.3% vs. 7.6%). In the comparison of previous disease history, bronchial asthma (25.0% vs. 3.1%, p=0.004), hypertension (58.3% vs. 21.5%, p=0.008), malignant disease (25.0% vs. 4.6%, p=0.007), history of organ transplantation and steroid administration (8.3% vs. 0%, p=0.019) were significantly higher in the indeterminate group than in the determinate group. The history of ICU stay was shown in 7 patients (58.3%) within the indeterminate group, which was significantly higher than that of the determinate group (18.5%, 12/65) (p=0.003). However, the median hospital stay of the indeterminate group was shown to be 15.0 (IQR, 5.0~40.0), which showed no difference with that of the determinate group (16.5; IQR, 7.0~38.0). The death rate of the indeterminate group was shown to be 25.0% (3 patients), which was higher than that of the determinate group (7.7%, 5/65), but was not statistically significant (p=0.071). In multivariate analysis, in the cases of age of 65 years or higher (odds ratio [OR], 11.29; p=0.026), bronchial asthma (OR, 51.66; p=0.028), malignant diseases (OR, 5.90; p=0.078) and history of ICU stay (OR, 15.47; p=0.018), the frequency was shown to be higher in the indeterminate group than in the determinate group (Table 4).


Factors Associated with Indeterminate and False Negative Results of QuantiFERON-TB Gold In-Tube Test in Active Tuberculosis.

Cho K, Cho E, Kwon S, Im S, Sohn I, Song S, Kim H, Kim S - Tuberc Respir Dis (Seoul) (2012)

The proportion of determinate and indeterminate QFT-GIT results in each age group. QFT-GIT: Quanti-FERON-TB Gold In-Tube.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3475462&req=5

Figure 1: The proportion of determinate and indeterminate QFT-GIT results in each age group. QFT-GIT: Quanti-FERON-TB Gold In-Tube.
Mentions: The median age of the indeterminate group was shown to be 70.5 years (IQR, 55.5~76.0), which was significantly higher than that of the determinate group (51.0, IQR 41~66.0) (p=0.011). The age distribution of patients showing indeterminate results on QFT-GIT test is shown in Figure 1. Indeterminate results were significantly more frequent among the age bracket of 65 years or higher (25.0% with indeterminate results vs. 18.4% with determinate results) and age bracket of 75 years or higher (33.3% vs. 7.6%). In the comparison of previous disease history, bronchial asthma (25.0% vs. 3.1%, p=0.004), hypertension (58.3% vs. 21.5%, p=0.008), malignant disease (25.0% vs. 4.6%, p=0.007), history of organ transplantation and steroid administration (8.3% vs. 0%, p=0.019) were significantly higher in the indeterminate group than in the determinate group. The history of ICU stay was shown in 7 patients (58.3%) within the indeterminate group, which was significantly higher than that of the determinate group (18.5%, 12/65) (p=0.003). However, the median hospital stay of the indeterminate group was shown to be 15.0 (IQR, 5.0~40.0), which showed no difference with that of the determinate group (16.5; IQR, 7.0~38.0). The death rate of the indeterminate group was shown to be 25.0% (3 patients), which was higher than that of the determinate group (7.7%, 5/65), but was not statistically significant (p=0.071). In multivariate analysis, in the cases of age of 65 years or higher (odds ratio [OR], 11.29; p=0.026), bronchial asthma (OR, 51.66; p=0.028), malignant diseases (OR, 5.90; p=0.078) and history of ICU stay (OR, 15.47; p=0.018), the frequency was shown to be higher in the indeterminate group than in the determinate group (Table 4).

Bottom Line: Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay, lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels.In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32).Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.

ABSTRACT

Background: The sensitivities and specificities of interferon-gamma release assays (IGRAs) vary among different population studies, and the data on the routine use of IGRAs are limited. The aim of this study was to evaluate the role of QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of active tuberculosis.

Methods: We conducted a prospective study, enrolling 77 patients with suspected pulmonary tuberculosis (TB), at a secondary care teaching hospital in Seoul.

Results: In total, 12 (15.6%) patients showed indeterminate results due to positive control failure on the QFT-GIT test. Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay, lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels. Of the 77 patients, 44 (57.1%) were diagnosed with active pulmonary tuberculosis, and the percentage of false negative results of the QFT-GIT was 36.4% (vs. 31.8% with TST). In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32).

Conclusion: Indeterminate and false negative results of QFT-GIT test were not infrequent in tuberculosis, especially in the elderly. Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients.

No MeSH data available.


Related in: MedlinePlus