A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis

Anna Ralph, Muhamed Ardian, Andri Wiguna, Graeme P Maguire, Niels G Becker, Glen Drogumuller, Michael J Wilks, Govert Waramoi, Emiliana Tjitra, Sandjaja, Enny Kenangalem, Gysje Pontororing, Nicholas Anstey, Paul Kelly

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)863-869
Number of pages7
JournalThorax
Volume65
Issue number10
DOIs
Publication statusPublished - 2010

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Pulmonary Tuberculosis
Thorax
X-Rays
Tuberculosis
Lung
Sputum
Clinical Trials
Exercise Tolerance
Indonesia
Microscopy
Hemoglobins
Body Mass Index
Quality of Life
Datasets

Cite this

Ralph, A., Ardian, M., Wiguna, A., Maguire, G. P., Becker, N. G., Drogumuller, G., ... Kelly, P. (2010). A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis. Thorax, 65(10), 863-869. https://doi.org/10.1136/thx.2010.136242
Ralph, Anna ; Ardian, Muhamed ; Wiguna, Andri ; Maguire, Graeme P ; Becker, Niels G ; Drogumuller, Glen ; Wilks, Michael J ; Waramoi, Govert ; Tjitra, Emiliana ; Sandjaja ; Kenangalem, Enny ; Pontororing, Gysje ; Anstey, Nicholas ; Kelly, Paul. / A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis. In: Thorax. 2010 ; Vol. 65, No. 10. pp. 863-869.
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abstract = "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.",
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Ralph, A, Ardian, M, Wiguna, A, Maguire, GP, Becker, NG, Drogumuller, G, Wilks, MJ, Waramoi, G, Tjitra, E, Sandjaja, Kenangalem, E, Pontororing, G, Anstey, N & Kelly, P 2010, 'A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis', Thorax, vol. 65, no. 10, pp. 863-869. https://doi.org/10.1136/thx.2010.136242

A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis. / Ralph, Anna; Ardian, Muhamed; Wiguna, Andri; Maguire, Graeme P; Becker, Niels G; Drogumuller, Glen; Wilks, Michael J; Waramoi, Govert; Tjitra, Emiliana; Sandjaja; Kenangalem, Enny; Pontororing, Gysje; Anstey, Nicholas; Kelly, Paul.

In: Thorax, Vol. 65, No. 10, 2010, p. 863-869.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis

AU - Ralph, Anna

AU - Ardian, Muhamed

AU - Wiguna, Andri

AU - Maguire, Graeme P

AU - Becker, Niels G

AU - Drogumuller, Glen

AU - Wilks, Michael J

AU - Waramoi, Govert

AU - Tjitra, Emiliana

AU - Sandjaja, null

AU - Kenangalem, Enny

AU - Pontororing, Gysje

AU - Anstey, Nicholas

AU - Kelly, Paul

PY - 2010

Y1 - 2010

N2 - 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.

AB - 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.

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