Dados do Trabalho

Título

Automated interpretation of chest X-rays predicts incident tuberculosis risk in a prospective cohort in prisons

Introdução

Previous studies demonstrated that chest X-ray (CXR) automated interpretation had high accuracy in screening for prevalent tuberculosis (TB). However, whether CXR automated interpretation predicts later development of TB disease is unknown.

Objetivo (s)

Active case finding is recommended in prisons; however, there is a need to identify which individuals are at highest risk of incident tuberculosis after initially screening negative for TB. We enrolled a prospective cohort of incarcerated individuals who screened negative for tuberculosis to identify predictors of incident disease. 

Material e Métodos

We enrolled a prospective cohort of incarcerated individuals in two Brazilian prisons from February 2023. Eligible participants included adults (≤18 years) with at least 12-months remaining sentence. We performed baseline screening using CXR, two sputum samples for Xpert Ultra and one for culture; individuals found to have active TB through this screening were treated and excluded. Cohort participants were followed-up every four months with CXR and sputum sample collection for Xpert Ultra and culture. We used LunitTB to score CXR images and categorized them into “low” (scores ≤50) or “high” (scores >50). TB incidence was defined as a positive result on either Xpert or sputum culture tests during follow-up. Incidence rates (IR) and 95% confidence intervals (CI) were reported per 100 person-years. 

Resultados e Conclusão

 Among 2469 individuals who were TB-negative at baseline, 1715 with ≥1 follow-up visit information available were included. We identified incident TB among 4.1% of participants (70/1711) during 974 person-years (IR=7.2 per 100 person-years, 95%CI 5.6 – 9.0). Baseline LunitTB scores were significantly higher among individuals with incident TB (median=83.7, interquartile range [IQR] 27.9, 97.9) compared to those without incident TB (median=34.8, IQR 18.4, 56.9) (p<0.01). TB incidence was significantly higher among individuals with high LunitTB scores (IR=13.8, 95%CI 10.0 – 18.6) compared to those with low LunitTB scores (IR=4.1, 95%CI 2.7 – 5.9; IR ratio=3.4, 95%CI 2.1 – 5.6). Through intensive longitudinal screening, we identified extremely high rates of incident TB in a cohort of incarcerated individuals who screened negative at baseline. High baseline LunitTB scores were highly predictive of incident tuberculosis. The use of automated CXR interpretations in carceral settings may help identify individuals at risk of incident TB. 

Palavras Chave

Tuberculosis; active case finding; chest x-ray; automated x-ray interpretation