Sistema de Salut de Catalunya
[Riestra S] Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain. [Taxonera C] Gastroenterology Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. [Zabana Y] Gastroenterology Department, Hospital Universitari Mútua Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa, Spain. [Carpio D] Gastroenterology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain. [Chaparro M] Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. [Barrio J] Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain. [Piqueras M] Servei de Gastroenterologia, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
Consorci Sanitari de Terrassa
2023-06-22T11:57:48Z
2023-06-22T11:57:48Z
2022-07-05
Inflammatory bowel disease; Interferon gamma release assays; Latent tuberculosis infection
Enfermedad inflamatoria intestinal; Ensayos de liberación de interferón gamma; Infección tuberculosa latente
Malaltia inflamatòria intestinal; Assajos d'alliberament gamma d'interferó; Infecció tuberculosa latent
Aims: Patients receiving antitumor necrosis factor (anti-TNF) therapy are at risk of developing tuberculosis (TB), usually due to the reactivation of a latent TB infection (LTBI). LTBI screening and treatment decreases the risk of TB. This study evaluated the diagnostic performance of different LTBI screening strategies in patients with inflammatory bowel disease (IBD). Methods: Patients in the Spanish ENEIDA registry with IBD screened for LTBI between January 2003 and January 2018 were included. The diagnostic yield of different strategies (dual screening with tuberculin skin test [TST] and interferon-ץ-release assay [IGRA], two-step TST, and early screening performed at least 12 months before starting biological treatment) was analyzed. Results: Out of 7594 screened patients, 1445 (19%; 95% CI 18−20%) had LTBI. Immunomodulator (IMM) treatment at screening decreased the probability of detecting LTBI (20% vs. 17%, p = 0.001). Regarding screening strategies, LTBI was more frequently diagnosed by dual screening than by a single screening strategy (IGRA, OR 0.60; 95% CI 0.50−0.73, p < 0.001; TST, OR 0.76; 95% CI 0.66−0.88, p < 0.001). Two-step TST increased the diagnostic yield of a single TST by 24%. More cases of LTBI were diagnosed by early screening than by routine screening before starting anti-TNF agents (21% [95% CI 20−22%] vs. 14% [95% CI 13−16%], p < 0.001). The highest diagnostic performance for LTBI (29%) was obtained by combining early and TST/IGRA dual screening strategies in patients without IMM. Conclusions: Both early screening and TST/IGRA dual screening strategies significantly increased diagnostic performance for LTBI in patients with IBD, with optimal performance achieved when they are used together in the absence of IMM.
Article
Published version
English
Interferó; Tuberculosi; Intestins - Inflamació; DISEASES::Digestive System Diseases::Gastrointestinal Diseases::Gastroenteritis::Inflammatory Bowel Diseases; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Clinical Laboratory Techniques::Immunologic Tests::Interferon-gamma Release Tests; DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Actinomycetales Infections::Mycobacterium Infections::Tuberculosis::Latent Tuberculosis; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::gastroenteritis::enfermedad inflamatoria intestinal; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::técnicas de laboratorio clínico::pruebas inmunológicas::análisis de la liberación del interferón gamma; ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias grampositivas::infecciones por Actinomycetales::micobacteriosis::tuberculosis::tuberculosis latente
MDPI
Journal of Clinical Medicine;11(13)
https://doi.org/10.3390/jcm11133915
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
