Risk factors for false-negative T-SPOT.TB assay results in patients with pulmonary and extra-pulmonary TB

  • Liping Pan
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Hongyan Jia
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Fei Liu
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Huishan Sun
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Mengqiu Gao
    Affiliations
    Tuberculosis Department, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
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  • Fengjiao Du
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Aiying Xing
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Boping Du
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Qi Sun
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Rongrong Wei
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Shuxiang Gu
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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  • Zongde Zhang
    Correspondence
    Corresponding author. Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, 97 Machang Road, Tongzhou District, Beijing 101149, China. Tel./fax: +86 10 89509155.
    Affiliations
    Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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Published:January 16, 2015DOI:https://doi.org/10.1016/j.jinf.2014.12.018

      Highlights

      • Increased age is a risk factor for false-negative T-SPOT.TB results in PTB and EPTB.
      • Over-weight is a risk factor for false-negative T-SPOT.TB results in PTB.
      • Longer period of illness is a risk factor for false-negative T-SPOT.TB in PTB.
      • PTB and EPTB are different in the risk factors for false-negative T-SPOT.TB results.

      Summary

      Objectives

      To investigate the risk factors for false-negative T-SPOT.TB results in patients with pulmonary TB (PTB) and extra-pulmonary TB (EPTB).

      Methods

      Patients with suspected TB who underwent valid T-SPOT.TB tests were prospectively enrolled at Beijing Chest Hospital between November 2012 and November 2013. Basic characters and clinical laboratory findings were compared between true-positive and false-negative T-SPOT.TB groups.

      Results

      Of 1928 suspected TB patients, 774 (530 PTB and 244 EPTB) microbiologically/histopathogenically-confirmed patients (636 culture-confirmed) were analyzed. Forty-six PTB patients (8.7%) and 32 EPTB patients (13.1%) had negative T-SPOT.TB results. Multivariate analysis showed that increased age [odds radio (OR) 2.26, 95% confidence interval (CI) 1.11–4.58], over-weight (BMI ≥ 25 kg/m2, OR 2.43, 95% CI 1.05–5.63), and a longer period of illness before hospitalization (>6 months, OR 2.46, 95% CI 1.24–4.92) were independent risk factors for false-negative T-SPOT.TB results in PTB patients. In EPTB patients, increased age (OR 2.42, 95% CI 1.09–5.35) also showed an independent association with false-negative T-SPOT.TB results.

      Conclusion

      Careful interpretation of negative T-SPOT.TB results is necessary in older patients with suspected PTB or EPTB, and in PTB patients who are over-weight or have had longer periods of illness before hospitalization.

      Keywords

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