IGRA testing in patients with immune-mediated inflammatory diseases: which factors influence the results?

Rheumatol Int. 2018 Feb;38(2):267-273. doi: 10.1007/s00296-017-3852-9. Epub 2017 Oct 19.

Abstract

Diagnosis of latent tuberculosis infection in patients with immune-mediated inflammatory chronic diseases (IMIDs) can be challenged as diagnostic test reliability could be impaired by immunosuppression. We retrospectively analyzed the Quantiferon Gold-Test in-Tube (QFT-G-IT) results of all patients with IMIDs seen at the Department of Internal Medicine of Son Llàtzer Hospital, Palma de Mallorca (Spain), looking for the factors related to QFT-G-IT indeterminate results. During the study period (2008-2015), 520 patients met the inclusion criteria. Factors associated with indeterminate QFT-G-IT results in a univariate analysis were inflammatory bowel disease, disease activity, lymphopenia, and medium-to-high doses of corticosteroids. In a subsequent multivariate analysis, only lymphopenia (defined as < 1500 cells) was associated with indeterminate QFT-G-IT results. Lymphocyte count was the only factor independently associated with an increased number of indeterminate QFT-G-IT results in patients with different autoimmune diseases. Others factors such as the use of medium-to-high doses of corticosteroids should be considered before testing with QFT-G-IT.

Keywords: Autoimmune diseases; IGRA; Quantiferon; Tuberculosis infection.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects
  • Adult
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Female
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects
  • Inflammation / diagnosis
  • Inflammation / drug therapy
  • Inflammation / immunology*
  • Interferon-gamma Release Tests*
  • Latent Tuberculosis / diagnosis*
  • Latent Tuberculosis / immunology
  • Latent Tuberculosis / microbiology
  • Logistic Models
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Spain
  • Tuberculin Test*
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents