The Pitfalls of Mining for QuantiFERON Gold in Severely Ill Patients With COVID-19
© 2022 The Authors..
Objective: To assess the proportion of indeterminate QuantiFERON-TB Gold Plus (QFT-Plus) results in patients admitted for severe coronavirus disease 2019 (COVID-19) pneumonia and evaluate the factors associated with indeterminate QFT-Plus results.
Patients and Methods: Data on COVID-19 admissions at Mayo Clinic in Florida were extracted between October 13, 2020, and September 20, 2021, and data from a prepandemic cohort were extracted between October 13, 2018, and September 20, 2019. A secondary analysis of the COVID-19 cohort was performed using gradient boosting modeling to generate variable importance and SHapley Additive exPlanations plots.
Results: Our findings demonstrated more indeterminate QFT-Plus test results in patients hospitalized for severe COVID-19 infection than in patients without COVID-19 (139 of 495, 28.1%). The factors associated with indeterminate QFT-Plus test results included elevated levels of C-reactive protein, ferritin, lactate dehydrogenase and interleukin-6 and included lower levels of leukocyte, lymphocyte, and platelet counts.
Conclusion: The patients with severe COVID-19 had a higher likelihood of indeterminate QFT-Plus results, which were associated with elevated levels of inflammatory markers consistent with severe infection. Interferon-gamma release assay screening tests are likely confounded by COVID-19 infection itself, limiting the screening ability for latent tuberculosis infection reactivation. Indeterminate QFT-Plus results may also require follow-up QFT-Plus testing after patient recovery from COVID-19, increasing the cost and complexity of medical decision making and management. Additional risk assessments may be needed in this patient population for screening for latent tuberculosis infection in patients with severe COVID-19.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:6 |
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| Enthalten in: |
Mayo Clinic proceedings. Innovations, quality & outcomes - 6(2022), 5 vom: 18. Okt., Seite 409-419 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cortes, Melissa P [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 19.08.2022 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.mayocpiqo.2022.06.004 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM343387743 |
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| 100 | 1 | |a Cortes, Melissa P |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Pitfalls of Mining for QuantiFERON Gold in Severely Ill Patients With COVID-19 |
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| 500 | |a Date Revised 19.08.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2022 The Authors. | ||
| 520 | |a Objective: To assess the proportion of indeterminate QuantiFERON-TB Gold Plus (QFT-Plus) results in patients admitted for severe coronavirus disease 2019 (COVID-19) pneumonia and evaluate the factors associated with indeterminate QFT-Plus results | ||
| 520 | |a Patients and Methods: Data on COVID-19 admissions at Mayo Clinic in Florida were extracted between October 13, 2020, and September 20, 2021, and data from a prepandemic cohort were extracted between October 13, 2018, and September 20, 2019. A secondary analysis of the COVID-19 cohort was performed using gradient boosting modeling to generate variable importance and SHapley Additive exPlanations plots | ||
| 520 | |a Results: Our findings demonstrated more indeterminate QFT-Plus test results in patients hospitalized for severe COVID-19 infection than in patients without COVID-19 (139 of 495, 28.1%). The factors associated with indeterminate QFT-Plus test results included elevated levels of C-reactive protein, ferritin, lactate dehydrogenase and interleukin-6 and included lower levels of leukocyte, lymphocyte, and platelet counts | ||
| 520 | |a Conclusion: The patients with severe COVID-19 had a higher likelihood of indeterminate QFT-Plus results, which were associated with elevated levels of inflammatory markers consistent with severe infection. Interferon-gamma release assay screening tests are likely confounded by COVID-19 infection itself, limiting the screening ability for latent tuberculosis infection reactivation. Indeterminate QFT-Plus results may also require follow-up QFT-Plus testing after patient recovery from COVID-19, increasing the cost and complexity of medical decision making and management. Additional risk assessments may be needed in this patient population for screening for latent tuberculosis infection in patients with severe COVID-19 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19, coronavirus disease 2019 | |
| 650 | 4 | |a CRP, C-reactive protein | |
| 650 | 4 | |a GBM, gradient boosting machine | |
| 650 | 4 | |a IGRA, interferon-gamma release assay | |
| 650 | 4 | |a LDH, lactate dehydrogenase | |
| 650 | 4 | |a LTBI, latent tuberculosis infection | |
| 650 | 4 | |a QFT-Plus, QuantiFERON-TB Gold Plus | |
| 650 | 4 | |a SHAP, SHapley Additive exPlanations | |
| 700 | 1 | |a Schultz, Carrie S |e verfasserin |4 aut | |
| 700 | 1 | |a Isha, Shahin |e verfasserin |4 aut | |
| 700 | 1 | |a Sinclair, Jorge E |e verfasserin |4 aut | |
| 700 | 1 | |a Bhakta, Shivang |e verfasserin |4 aut | |
| 700 | 1 | |a Kunze, Katie L |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Patrick W |e verfasserin |4 aut | |
| 700 | 1 | |a Cowart, Jennifer B |e verfasserin |4 aut | |
| 700 | 1 | |a Carter, Rickey E |e verfasserin |4 aut | |
| 700 | 1 | |a Franco, Pablo Moreno |e verfasserin |4 aut | |
| 700 | 1 | |a Sanghavi, Devang K |e verfasserin |4 aut | |
| 700 | 1 | |a Roy, Archana |e verfasserin |4 aut | |
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