{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:55:20Z","timestamp":1791644120984,"version":"4.3.4"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T00:00:00Z","timestamp":1665705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["K23AI143479"],"award-info":[{"award-number":["K23AI143479"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["K24AI114444 to"],"award-info":[{"award-number":["K24AI114444 to"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["U19AI111211"],"award-info":[{"award-number":["U19AI111211"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006939","name":"Emory University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006939","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Center for AIDS Research","award":["P30AI050409"],"award-info":[{"award-number":["P30AI050409"]}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NIH","award":["K43TW011422"],"award-info":[{"award-number":["K43TW011422"]}]},{"name":"NIH","award":["UL1-TR002378"],"award-info":[{"award-number":["UL1-TR002378"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Clinical pediatric tuberculosis (TB) diagnosis may lead to overdiagnosis particularly among children with human immunodeficiency virus (CHIV). We assessed the performance of monocyte-lymphocyte ratio (MLR) as a diagnostic biomarker and constructed a clinical prediction score to improve specificity of TB diagnosis in CHIV with limited access to microbiologic testing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We pooled data from cohorts of children aged \u226413 years from Vietnam, Cameroon, and South Africa to validate the use of MLR \u22650.378, previously found as a TB diagnostic marker among CHIV. Using multivariable logistic regression, we created an internally validated prediction score for diagnosis of TB disease in CHIV.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The combined cohort had 601 children (median age, 1.9 [interquartile range, 0.9\u20135.3] years); 300 (50%) children were male, and 283 (47%) had HIV. Elevated MLR \u22650.378 had sensitivity of 36% (95% confidence interval [CI], 23%\u201351%) and specificity of 79% (95% CI, 71%\u201386%) among CHIV in the validation cohort. A model using MLR \u22650.28, age \u22654 years, tuberculin skin testing \u22655\u2005mm, TB contact history, fever &amp;gt;2 weeks, and chest radiograph suggestive of TB predicted active TB disease in CHIV with an area under the receiver operating characteristic curve of 0.85. A prediction score of \u22655 points had a sensitivity of 94% and specificity of 48% to identify confirmed TB, and a sensitivity of 82% and specificity of 48% to identify confirmed and unconfirmed TB groups combined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our score has comparable sensitivity and specificity to algorithms including microbiological testing and should enable clinicians to rapidly initiate TB treatment among CHIV when microbiological testing is unavailable.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofac548","type":"journal-article","created":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T21:39:32Z","timestamp":1665783572000},"source":"Crossref","is-referenced-by-count":13,"title":["Development of a Clinical Prediction Score Including Monocyte-to-Lymphocyte Ratio to Inform Tuberculosis Treatment Among Children With HIV: A Multicountry Study"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4875-9916","authenticated-orcid":false,"given":"Amyn A","family":"Malik","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA"},{"name":"Yale Institute for Global Health , New Haven, Connecticut , USA"},{"name":"Yale School of Medicine , New Haven, Connecticut , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neel R","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3350-112X","authenticated-orcid":false,"given":"Olivier","family":"Marcy","sequence":"additional","affiliation":[{"name":"Epidemiology and Public Health Unit, Institut Pasteur du Cambodge , Phnom Penh , Cambodia"},{"name":"Centre INSERM U1219, Bordeaux Population Health, University of Bordeaux , Bordeaux , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Walters","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa"},{"name":"John Walton Muscular Dystrophy Research Centre, Newcastle University , Newcastle-upon-Tyne , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathurin","family":"Tejiokem","sequence":"additional","affiliation":[{"name":"Centre Pasteur du Cameroon , Yaound\u00e9 , Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giang Do","family":"Chau","sequence":"additional","affiliation":[{"name":"Giang Do Chau, Pham Ngoc Thach Hospital , Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad B","family":"Omer","sequence":"additional","affiliation":[{"name":"Yale Institute for Global Health , New Haven, Connecticut , USA"},{"name":"Yale School of Medicine , New Haven, Connecticut , USA"},{"name":"Yale School of Public Health , New Haven, Connecticut , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy L","family":"Lash","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes C","family":"Becerra","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School , Boston, Massachusetts , USA"},{"name":"Division of Global Health Equity, Brigham and Women's Hospital , Boston, Massachusetts , USA"},{"name":"Partners In Health , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene N","family":"Njuguna","sequence":"additional","affiliation":[{"name":"Department of Research and Programs , Kenyatta National Hospital, Nairobi , Kenya"},{"name":"Department of Global Health, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9809-5997","authenticated-orcid":false,"given":"Sylvia M","family":"LaCourse","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Maleche-Obimbo","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, University of Nairobi , Nairobi , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalton","family":"Wamalwa","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, University of Nairobi , Nairobi , 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