期刊
OPEN FORUM INFECTIOUS DISEASES
卷 5, 期 8, 页码 -出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofy184
关键词
foreign-born; interferon gamma release assay; indeterminate; latent tuberculosis
资金
- National Center for Research Resources/National Institutes of Health (NIH) [UL1TR000423]
- ITHS grant [UL1 TR002319]
- National Institute of Allergy and Infectious Diseases/NIH [T32 AI07140]
Background. Non-US-born individuals account for the majority of active tuberculosis (TB) in the United States. Interferon gamma release assay (IGRA) is the preferred diagnostic test for latent TB but can produce an indeterminate result. We investigated the prevalence and predictors of an indeterminate IGRA (IND-IGRA) in a diverse cohort of non-US-born individuals and evaluated outcomes after IND-IGRA. Methods. We identified patient age >= 18 years who had an outpatient IGRA between 2010 and 2017 in our health system and whose primary language was not English. We used univariate and multivariable logistic regression to examine the association of IND-IGRA with a variety of clinical factors. Results. Of 3128 outpatients with >= 1 IGRA done, 33% were Asian, 30% Hispanic, and 29% black; 44% were men, and the median age was 50 years. An initial IND-IGRA occurred in 118 (3.8%; 95% confidence interval [CI], 3.1%-4.5%); notably, Asian race (55%) and rheumatologic conditions (25%) were prevalent in this group. In multivariable analysis, Asian race was independently associated with IND-IGRA (adjusted odds ratio [aOR], 29; 95% CI, 1.9-4.3), in addition to the presence of anemia and hypoalbuminemia (aOR for interaction, 4.3; 95% CI, 1.3-14.3). Only 55% of patients with an initial IND-IGRA underwent repeat testing; of those who did, 66% had a determinate result. Conclusions. Asian race and anernia/hypoalbuminemia were independent risk factors for an indeterminate IGRA outcome in foreign-born patients screened in the United States. Our study underscores the importance of following through on indeterminate results in these key subgroups.
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