{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T20:18:11Z","timestamp":1772223491112,"version":"3.50.1"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fuyang Municipal Health Commission","award":["FY2023-036"],"award-info":[{"award-number":["FY2023-036"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec017\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to explore factors influencing false-negative results in Interferon-Gamma Release Assay (IGRA) for patients with Pulmonary Tuberculosis (PTB), and develop a nomogram model to predict IGRA false negatives, thereby optimizing clinical diagnosis and treatment decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec018\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected from January 2023 to September 2024 at the Second People\u2019s Hospital of Fuyang City, involving 143 PTB patients. Among them, 63 patients who were IGRA negative but pathogen positive formed the observation group, while 80 patients who were both IGRA and pathogen positive constituted the control group. Propensity Score Matching (PSM) was used to balance potential confounding factors between the two groups. Clinical characteristics and laboratory indicators were compared, followed by logistic regression analysis to identify independent risk factors affecting IGRA results. A nomogram model was constructed based on these factors and its predictive performance evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec019\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After PSM, each group consisted of 55 patients. The observation group showed significantly lower levels of white blood cell count (WBC), neutrophil count (NEUT), lymphocyte count (LYM), red blood cell count (RBC), hemoglobin (HGB), and albumin (ALB) compared to the control group (P\u2009&lt;\u20090.05). Multivariate analysis ultimately identified RBC, ALB and NLR as independent predictors of IGRA false-negativity. The developed nomogram model demonstrated good calibration (\u03c7\u00b2\u2009=\u20094.482, P\u2009=\u20090.811), with an area under the receiver operating characteristic curve (AUC) of 0.764 (95% CI: 0.675\u22120.853). Decision curve analysis indicated that the net benefit of predicting false-negative IGRA results using this nomogram model was greater than 0 when the threshold probability ranged from 0.15 to 0.95.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec020\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Decreased RBC\/ALB and elevated NLR may be pivotal factors contributing to false-negative IGRA results in PTB patients. The three-variable nomogram shows enhanced predictive performance, serving as a quantitative tool to identify high-risk cases, particularly for patients with malnutrition or pronounced inflammatory status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0327767","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T13:54:27Z","timestamp":1751464467000},"page":"e0327767","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a nomogram for predicting false negative IGRA results in pulmonary tuberculosis patients using propensity score matching"],"prefix":"10.1371","volume":"20","author":[{"given":"Feng","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tuantuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2508-8428","authenticated-orcid":true,"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"issue":"1","key":"pone.0327767.ref001","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1080\/07853890.2022.2085318","article-title":"Incidence and prevalence of pulmonary tuberculosis among patients with type 2 diabetes mellitus: a systematic review and meta-analysis","volume":"54","author":"Q Wu","year":"2022","journal-title":"Ann Med"},{"key":"pone.0327767.ref002","doi-asserted-by":"crossref","first-page":"927031","DOI":"10.3389\/fmicb.2022.927031","article-title":"Heterologous prime-boost BCG with DNA vaccine expressing fusion antigens Rv2299c and Ag85A improves protective efficacy against Mycobacterium tuberculosis in mice","volume":"13","author":"J Wu","year":"2022","journal-title":"Front Microbiol"},{"key":"pone.0327767.ref003","volume-title":"Global tuberculosis report 2023","author":"World Health Organization","year":"2023"},{"issue":"1","key":"pone.0327767.ref004","first-page":"51","article-title":"The importance of early detection in disease management","volume":"2","author":"R Setyawati","year":"2024","journal-title":"Journal of World Future Medicine, Health and Nursing"},{"issue":"3","key":"pone.0327767.ref005","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1093\/clinchem\/hvad220","article-title":"A Retrospective Study of Factors Contributing to the Performance of an Interferon-Gamma Release Assay Blood Test for Tuberculosis Infection","volume":"70","author":"J Song","year":"2024","journal-title":"Clin Chem"},{"issue":"3","key":"pone.0327767.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0299874","article-title":"Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia","volume":"19","author":"L Apriani","year":"2024","journal-title":"PLoS One"},{"issue":"12","key":"pone.0327767.ref007","article-title":"Host factors associated with false negative results in an interferon-\u03b3 release assay in adults with active tuberculosis","volume":"9","author":"Q Liu","year":"2023","journal-title":"Heliyon"},{"issue":"4","key":"pone.0327767.ref008","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.21037\/jtd-21-1723","article-title":"Clinical relevance of false-negative interferon-gamma release assays in patients with tuberculous pleurisy in an intermediate tuberculosis burden country","volume":"14","author":"KH Kim","year":"2022","journal-title":"J Thorac Dis"},{"issue":"1","key":"pone.0327767.ref009","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3390\/diagnostics13010088","article-title":"Predictors for False-Negative Interferon-Gamma Release Assay Results in Hemodialysis Patients with Latent Tuberculosis Infection","volume":"13","author":"H Park","year":"2022","journal-title":"Diagnostics (Basel)"},{"issue":"1","key":"pone.0327767.ref010","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/biomet\/70.1.41","article-title":"The central role of the propensity score in observational studies for causal effects","volume":"70","author":"PR Rosenbaum","year":"1983","journal-title":"Biometrika"},{"key":"pone.0327767.ref011","unstructured":"National Health Commission of the People\u2019s Republic of China. 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