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

    Fingerprint

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