Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru

Descripción del Articulo

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Detalles Bibliográficos
Autores: Solari, L, Van der Stuyft, P, Soto, Alonso
Formato: artículo
Fecha de Publicación:2018
Institución:Universidad Peruana de Ciencias Aplicadas
Repositorio:UPC-Institucional
Lenguaje:inglés
OAI Identifier:oai:repositorioacademico.upc.edu.pe:10757/624693
Enlace del recurso:http://hdl.handle.net/10757/624693
Nivel de acceso:acceso embargado
Materia:adenosine deaminase
meningitis
Mycobacterium tuberculosis
score
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dc.title.en_US.fl_str_mv Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
title Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
spellingShingle Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
Solari, L
adenosine deaminase
meningitis
Mycobacterium tuberculosis
score
title_short Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
title_full Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
title_fullStr Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
title_full_unstemmed Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
title_sort Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
author Solari, L
author_facet Solari, L
Van der Stuyft, P
Soto, Alonso
author_role author
author2 Van der Stuyft, P
Soto, Alonso
author2_role author
author
dc.contributor.email.es_PE.fl_str_mv pcmeasot@upc.edu.pe
dc.contributor.author.fl_str_mv Solari, L
Van der Stuyft, P
Soto, Alonso
dc.subject.en_US.fl_str_mv adenosine deaminase
meningitis
Mycobacterium tuberculosis
score
topic adenosine deaminase
meningitis
Mycobacterium tuberculosis
score
description El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
publishDate 2018
dc.date.accessioned.none.fl_str_mv 2018-11-30T03:15:24Z
dc.date.available.none.fl_str_mv 2018-11-30T03:15:24Z
dc.date.issued.fl_str_mv 2018-04
dc.type.en_US.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/10757/624693
dc.identifier.journal.en_US.fl_str_mv Tropical Medicine and International Health
dc.identifier.isni.none.fl_str_mv 0000 0001 2196 144X
url http://hdl.handle.net/10757/624693
identifier_str_mv Tropical Medicine and International Health
0000 0001 2196 144X
dc.language.iso.en_US.fl_str_mv eng
language eng
dc.rights.en_US.fl_str_mv info:eu-repo/semantics/embargoedAccess
eu_rights_str_mv embargoedAccess
dc.format.en_US.fl_str_mv application/pdf
dc.publisher.en_US.fl_str_mv Blackwell Publishing Ltd
dc.source.es_PE.fl_str_mv Universidad Peruana de Ciencias Aplicadas (UPC)
Repositorio Academico - UPC
dc.source.none.fl_str_mv reponame:UPC-Institucional
instname:Universidad Peruana de Ciencias Aplicadas
instacron:UPC
instname_str Universidad Peruana de Ciencias Aplicadas
instacron_str UPC
institution UPC
reponame_str UPC-Institucional
collection UPC-Institucional
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spelling 86cbc5c704d6f97a482201da5323efec-1d8f6daa1c1d998e457709d57b1363b22-17473a091cd0c9a8f326934c380735d1b500Solari, LVan der Stuyft, PSoto, Alonsopcmeasot@upc.edu.pe2018-11-30T03:15:24Z2018-11-30T03:15:24Z2018-04http://hdl.handle.net/10757/624693Tropical Medicine and International Health0000 0001 2196 144XEl texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Objectives: Diagnosis of tuberculous meningitis (TM) is a challenge in countries with a high burden of the disease and constrained resources and clinical prediction rules (CPRs) could be of assistance. We aimed at developing a CPR for diagnosis of TM in a Latin American setting with high tuberculosis incidence and a concentrated HIV epidemic. Methods: We enrolled adult patients with clinical suspicion of TM attending two hospitals in Lima, Peru. We obtained information on potential anamnestic, clinical and laboratory predictive findings that are easy to collect and promptly available. We independently diagnosed TM according to a composite reference standard that included a series of microbiological tests. We performed bivariate analysis and constructed a logistic regression model to select the predictive findings associated with TM. With the selected predictors included in the model, we developed a score-based CPR. We assessed its internal validity and diagnostic performance. Results: Of 155 analysed patients, 59 (38%) had TM. The CPR we derived includes three predictors: cough for 14 days or more, 10–500 cells in CSF and adenosine deaminase ≥ 6 U/l in CSF. It classifies patients into high-, moderate- or low-score groups and has an overall area under the ROC curve of 0.87. 59% of patients were assigned to either the high- or the low-score group, permitting prompt decision-making. In patients in the high-score group, it attains a positive likelihood ratio for TM of 10.6 and in patients with low scores, a negative likelihood ratio of 0.10. Bootstrap analysis indicated high internal validity. Conclusion: This CPR could support decision-making in patients with clinical suspicion of TM. External validation and further assessment of its clinical impact are necessary before application in other settings.Revisión por paresapplication/pdfengBlackwell Publishing Ltdinfo:eu-repo/semantics/embargoedAccessUniversidad Peruana de Ciencias Aplicadas (UPC)Repositorio Academico - UPCreponame:UPC-Institucionalinstname:Universidad Peruana de Ciencias Aplicadasinstacron:UPCadenosine deaminasemeningitisMycobacterium tuberculosisscoreDevelopment of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peruinfo:eu-repo/semantics/article2018-11-30T03:16:50ZTHUMBNAIL10.1111 tmi.13041.pdf.jpg10.1111 tmi.13041.pdf.jpgGenerated Thumbnailimage/jpeg85490https://repositorioacademico.upc.edu.pe/bitstream/10757/624693/4/10.1111%20tmi.13041.pdf.jpg11c9aa36d9bad2b929c0bfcb2d624460MD54falseTEXT10.1111 tmi.13041.pdf.txt10.1111 tmi.13041.pdf.txtExtracted texttext/plain3678https://repositorioacademico.upc.edu.pe/bitstream/10757/624693/3/10.1111%20tmi.13041.pdf.txt0a786ef4238acf662f9cc308e8f11d29MD53falseORIGINAL10.1111 tmi.13041.pdf10.1111 tmi.13041.pdfapplication/pdf214726https://repositorioacademico.upc.edu.pe/bitstream/10757/624693/2/10.1111%20tmi.13041.pdfd001a6f02d78dc58f5ba692032cd1831MD52trueLICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repositorioacademico.upc.edu.pe/bitstream/10757/624693/1/license.txt8a4605be74aa9ea9d79846c1fba20a33MD51false10757/624693oai:repositorioacademico.upc.edu.pe:10757/6246932020-04-06 16:55:46.516Repositorio académico upcupc@openrepository.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Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru
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