Abstract
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.
【저자키워드】 Coronavirus disease 2019, C-reactive protein, lactate dehydrogenase, interferon-gamma release assay, COVID-19coronavirus disease 2019, CRPC-reactive protein, LDHlactate dehydrogenase, GBMgradient boosting machine, gradient boosting machine, IGRAinterferon-gamma release assay, LTBIlatent tuberculosis infection, latent tuberculosis infection, QFT-PlusQuantiFERON-TB Gold Plus, QuantiFERON-TB Gold Plus, SHAPSHapley Additive exPlanations, SHapley Additive exPlanations, 【초록키워드】 COVID-19, Severe infection, severe COVID-19, Pneumonia, interleukin-6, risk, ferritin, lymphocyte, Cohort, COVID-19 infection, management, Patient, Platelet, gold, Inflammatory marker, Follow-up, assessment, Interferon-gamma, screening test, Analysis, leukocyte, Severe COVID-19 Infection, Factor, Mayo Clinic, severe coronavirus disease, COVID-19 admission, patient population, indeterminate, COVID-19 cohort, objective, likelihood, Additive, Result, evaluate, proportion, generate, elevated, was performed, demonstrated, patients hospitalized, patients without COVID-19, 【제목키워드】 COVID-19, gold, QuantiFERON, Ill,