Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis

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dc.contributor.authorMurthy, S E
dc.contributor.authorChatterjee, F
dc.contributor.authorCrook, A
dc.contributor.authorDawson, R
dc.contributor.authorMendel, C
dc.contributor.authorMurphy, M E
dc.contributor.authorMurray, S R
dc.contributor.authorNunn, A J
dc.contributor.authorPhillips, P P J
dc.contributor.authorSingh, Kasha P
dc.contributor.authorMcHugh, T D
dc.contributor.authorGillespie, S H
dc.date.accessioned2018-05-28T10:04:40Z
dc.date.available2018-05-28T10:04:40Z
dc.date.issued2018-05-21
dc.date.updated2018-05-27T03:30:13Z
dc.description.abstractBackground Chest radiographs are used for diagnosis and severity assessment in tuberculosis (TB). The extent of disease as determined by smear grade and cavitation as a binary measure can predict 2-month smear results, but little has been done to determine whether radiological severity reflects the bacterial burden at diagnosis. Methods Pre-treatment chest x-rays from 1837 participants with smear-positive pulmonary TB enrolled into the REMoxTB trial (Gillespie et al., N Engl J Med 371:1577–87, 2014) were retrospectively reviewed. Two clinicians blinded to clinical details using the Ralph scoring system performed separate readings. An independent reader reviewed discrepant results for quality assessment and cavity presence. Cavitation presence was plotted against time to positivity (TTP) of sputum liquid cultures (MGIT 960). The Wilcoxon rank sum test was performed to calculate the difference in average TTP for these groups. The average lung field affected was compared to log 10 TTP by linear regression. Baseline markers of disease severity and patient characteristics were added in univariable regression analysis against radiological severity and a multivariable regression model was created to explore their relationship. Results For 1354 participants, the median TTP was 117 h (4.88 days), being 26 h longer (95% CI 16–30, p < 0.001) in patients without cavitation compared to those with cavitation. The median percentage of lung-field affected was 18.1% (IQR 11.3–28.8%). For every 10-fold increase in TTP, the area of lung field affected decreased by 11.4%. Multivariable models showed that serum albumin decreased significantly as the percentage of lung field area increased in both those with and without cavitation. In addition, BMI and logged TTP had a small but significant effect in those with cavitation and the number of severe TB symptoms in the non-cavitation group also had a small effect, whilst other factors found to be significant on univariable analysis lost this effect in the model. Conclusions The radiological severity of disease on chest x-ray prior to treatment in smear positive pulmonary TB patients is weakly associated with the bacterial burden. When compared against other variables at diagnosis, this effect is lost in those without cavitation. Radiological severity does reflect the overall disease severity in smear positive pulmonary TB, but we suggest that clinicians should be cautious in over-interpreting the significance of radiological disease extent at diagnosis.
dc.identifier.apacitationMurthy, S. E., Chatterjee, F., Crook, A., Dawson, R., Mendel, C., Murphy, M. E., ... Gillespie, S. H. (2018). Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis. <i>BMC Medicine</i>, http://hdl.handle.net/11427/28165en_ZA
dc.identifier.chicagocitationMurthy, S E, F Chatterjee, A Crook, R Dawson, C Mendel, M E Murphy, S R Murray, et al "Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis." <i>BMC Medicine</i> (2018) http://hdl.handle.net/11427/28165en_ZA
dc.identifier.citationBMC Medicine. 2018 May 21;16(1):73
dc.identifier.ris TY - Journal Article AU - Murthy, S E AU - Chatterjee, F AU - Crook, A AU - Dawson, R AU - Mendel, C AU - Murphy, M E AU - Murray, S R AU - Nunn, A J AU - Phillips, P P J AU - Singh, Kasha P AU - McHugh, T D AU - Gillespie, S H AB - Background Chest radiographs are used for diagnosis and severity assessment in tuberculosis (TB). The extent of disease as determined by smear grade and cavitation as a binary measure can predict 2-month smear results, but little has been done to determine whether radiological severity reflects the bacterial burden at diagnosis. Methods Pre-treatment chest x-rays from 1837 participants with smear-positive pulmonary TB enrolled into the REMoxTB trial (Gillespie et al., N Engl J Med 371:1577–87, 2014) were retrospectively reviewed. Two clinicians blinded to clinical details using the Ralph scoring system performed separate readings. An independent reader reviewed discrepant results for quality assessment and cavity presence. Cavitation presence was plotted against time to positivity (TTP) of sputum liquid cultures (MGIT 960). The Wilcoxon rank sum test was performed to calculate the difference in average TTP for these groups. The average lung field affected was compared to log 10 TTP by linear regression. Baseline markers of disease severity and patient characteristics were added in univariable regression analysis against radiological severity and a multivariable regression model was created to explore their relationship. Results For 1354 participants, the median TTP was 117 h (4.88 days), being 26 h longer (95% CI 16–30, p < 0.001) in patients without cavitation compared to those with cavitation. The median percentage of lung-field affected was 18.1% (IQR 11.3–28.8%). For every 10-fold increase in TTP, the area of lung field affected decreased by 11.4%. Multivariable models showed that serum albumin decreased significantly as the percentage of lung field area increased in both those with and without cavitation. In addition, BMI and logged TTP had a small but significant effect in those with cavitation and the number of severe TB symptoms in the non-cavitation group also had a small effect, whilst other factors found to be significant on univariable analysis lost this effect in the model. Conclusions The radiological severity of disease on chest x-ray prior to treatment in smear positive pulmonary TB patients is weakly associated with the bacterial burden. When compared against other variables at diagnosis, this effect is lost in those without cavitation. Radiological severity does reflect the overall disease severity in smear positive pulmonary TB, but we suggest that clinicians should be cautious in over-interpreting the significance of radiological disease extent at diagnosis. DA - 2018-05-21 DB - OpenUCT DP - University of Cape Town J1 - BMC Medicine LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis TI - Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis UR - http://hdl.handle.net/11427/28165 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12916-018-1053-3
dc.identifier.urihttp://hdl.handle.net/11427/28165
dc.identifier.vancouvercitationMurthy SE, Chatterjee F, Crook A, Dawson R, Mendel C, Murphy ME, et al. Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis. BMC Medicine. 2018; http://hdl.handle.net/11427/28165.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDivision of Infectious Disease and HIV Meden_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Medicine
dc.source.urihttps://bmcmedicine.biomedcentral.com/
dc.subject.otherPulmonary tuberculosis
dc.subject.otherchest x-ray
dc.subject.othercavitation
dc.subject.otherpretreatment
dc.titlePretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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