Ocular immunology and inflammation · 2025
Validation of the COTS Calculator for Tubercular Uveitis: Predictive Performance and Diagnostic Utility in an Indian Cohort.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Palani Janakiraman, Cifuentes Gonzalez Carlos, Patnaik Gazal, Rojas-Carabali William, Zhang Ludi, Thng Zheng Xian, Lee Bernett, Agrawal Rupesh, Biswas Jyotirmay
Аннотация
PURPOSE: Diagnosing ocular tuberculosis (OTB) is clinically challenging due to its paucibacillary nature and lack of definitive diagnostic tests. The Collaborative Ocular Tuberculosis Study (COTS) Calculator was developed as a clinical decision-support tool to guide anti-tubercular therapy (ATT) initiation. This study externally validates the COTS Calculator in a high-burden Indian cohort and assesses the additive value of radiological and immunological testing.
METHODS: This retrospective cohort study included 196 OTB patients treated between 2015 and 2022 at a tertiary eye care center in South India. Inclusion required complete diagnostic workup, ≥6-month follow-up post-ATT, and at least one supportive test (TST, IGRA, CT, or CXR). Two thresholds were evaluated: M4I1 (median ≥ 4) and M4I2 (median ≥ 4, IQR ≤ 2). Treatment response and recurrence were primary outcomes. Diagnostic performance was measured using AUC, sensitivity, specificity, PPV, and NPV. Composite scores (CT+CXR and TST+IGRA) were also analyzed.
RESULTS: The M4I2 threshold yielded higher sensitivity (83%) than M4I1 (60%) with comparable AUC (0.60 vs 0.58), though at lower specificity (38% vs 56%). Both thresholds achieved high PPV (94%) but poor NPV (11-17%). Composite testing showed similar high PPV (93%) and poor NPV (9-11%). Higher COTS scores and multiple positive tests correlated with favorable treatment response.
CONCLUSIONS: The COTS Calculator, particularly the M4I2 model, provides a useful clinical tool to guide ATT decisions in OTB. While limited in ruling out TB, its integration with radiological and immunological testing supports early treatment decisions in TB-endemic settings. Prospective validation is warranted.
METHODS: This retrospective cohort study included 196 OTB patients treated between 2015 and 2022 at a tertiary eye care center in South India. Inclusion required complete diagnostic workup, ≥6-month follow-up post-ATT, and at least one supportive test (TST, IGRA, CT, or CXR). Two thresholds were evaluated: M4I1 (median ≥ 4) and M4I2 (median ≥ 4, IQR ≤ 2). Treatment response and recurrence were primary outcomes. Diagnostic performance was measured using AUC, sensitivity, specificity, PPV, and NPV. Composite scores (CT+CXR and TST+IGRA) were also analyzed.
RESULTS: The M4I2 threshold yielded higher sensitivity (83%) than M4I1 (60%) with comparable AUC (0.60 vs 0.58), though at lower specificity (38% vs 56%). Both thresholds achieved high PPV (94%) but poor NPV (11-17%). Composite testing showed similar high PPV (93%) and poor NPV (9-11%). Higher COTS scores and multiple positive tests correlated with favorable treatment response.
CONCLUSIONS: The COTS Calculator, particularly the M4I2 model, provides a useful clinical tool to guide ATT decisions in OTB. While limited in ruling out TB, its integration with radiological and immunological testing supports early treatment decisions in TB-endemic settings. Prospective validation is warranted.