Eur Respirat J. NV 2011;6(6):e20061. sharing sensitive information, make sure youre on a federal 0000017048 00000 n Suite 100Las Vegas, Comparisons were made between the 3 groups using Kruskall-Wallis test for continuous variable, and the Chi-square test for qualitative variables. The patients who met these criteria were classified into three groups according to the mitogen result of the QFT (IFN- concentrations). A p-value < 0.05 was considered statistically significant. reduced by the IFN- concentration in nil tube. The lower and upper limits of agreement (mean difference 1.96 SD) were the greatest in the mitogen response with values of 7.1 IU/ml and + 6.6 IU/ml. The black mark on the side of the tubes indicates the 1.0 ml fill volume. *Correspondence: Mathieu Blot, mathieu.blot@chu-dijon.fr, https://www.frontiersin.org/articles/10.3389/fmed.2022.876864/full#supplementary-material, Creative Commons Attribution License (CC BY). 4. startxref 0000001563 00000 n The mitogen response (respectively normal, weak and negative) was associated with an increasing proportion of patient with onset of infectious complications (2, 5, 12%; p < 0.001), ICU admissions (3, 15, 32%; p < 0.001), hospital length of stay [median (interquartile range) = 5 (313); 11 (521) and 15 (1030) days; p < 0.001] and in-hospital mortality (3%, 7% and 15%; p < 0.001) (Figure 2 and Supplementary Table 6). When the severe infection at the time of the QFT variable was added in the model instead of the an ongoing infection at the time of QFT variable (model 2), the first variable was independently associated with both a negative (RR = 20.09; 95% CI = 8.6946.46) and a weak (RR = 7.10; 95% CI = 2.9317.23) mitogen response (Supplementary Table 2). Tuberculosis, or TB, is a highly contagious and infectious airborne disease that affects the respiratory system, particularly the lungs. LabReqs. quantiferon mitogen value normal range. The mitogen response of lymphocytes to untreated or heat-treated PWM and heat-treated Con A was increased in 1 mM Ca2+-supplemented groups, whereas the response . Posted in:homes for sale riverfront suffolk, va. Posted by: industrial revolution symbols . QFT4. TEST INFORMATION: The Quantiferon-TB Gold (QFTB-G) is a test recommended for detection of the cellular immune response to infection with Mycobacterium tuberculosis, the agent that causes tuberculosis (TB). Epub 2011 Jun 8. Posted: Feb 22nd, 2022 at 04:14PM Eur Respir J. <<022157bd818f5e479a168ae0d41e7b05>]>> Concurrent immune suppression and hyperinflammation in patients with community-acquired pneumonia. . Controls were defined as patients with a normal mitogen response IFN- > 2 IU/ml. 0000019861 00000 n J Infect Dis. Nil 8.0 and TB1 and TB2 <0.35 or 0.35 and <25% of Nil and Mitogen minus Nil <0.5 QFT-Plus Indeterminate 4 Detect TB infection with confidence 07/2017. It is generally recommended to results where Nil > 8.0 IU/ml (high background) consider . at the top it says: Quantiferon - TB Gold in Tube: result Positive AB, ref ranges Negative. The test is based on the quantification of interferon-gamma (IFN-) released from sensitized lymphocytes in whole blood incubated overnight with purified protein derivative (PPD) from M. tuberculosis and control antigens. Frequency and significance of indeterminate and borderline Quantiferon Gold TB IGRA results. The FDA's cutpoint for a positive result was established at >0.34 International Units/millilitre (IU/ml), though this has proven functionally problematic in low prevalence areas, such as among US and Canadian healthcare workers. First, the presence of an ongoing infection at the time of QFT was independently associated with a negative mitogen response and therefore indeterminate QFT results. After the blood sample is taken and analyzed, the QuantiFERON TB Gold test will render one of the following results: Negative or Normal. Normal range/expected value(s) for a specific disease state. A low response to mitogen (<0.5 IU/mL) indicates an Indeterminate result when a blood sample also has a The normal, weak and negative mitogen response (respectively) was associated with decreasing hemoglobin, albumin and lymphocyte counts, but increasing neutrophil count and C-reactive protein levels (Table 1). It does not distinguish between active and inactive tuberculosis. Tuberculosis (TB) was recorded if there were associated clinical-radiological signs of TB and it was confirmed with laboratory testing (Mycobacterium tuberculosis identification with culture and/or polymerase chain reaction). Log-linearity was tested for each continuous variable using fractional polynomials (20). For variables whose association with mitogen response was non-loglinear, the predicted probabilities of negative or weak response were estimated and plotted against the values of the variables, along with the CIs. This TB blood test is highly accurate, with sensitivity of 94% and specificity of 97%. To account for potential confounders, polytomous logistic regressions were fitted considering the normal mitogen response group as the reference. Terms & Conditions - doi: 10.1186/cc10112, 12. (2014) 58:320-4. Result Id. Finally, increasing C-reactive-protein (CRP) levels (15) or neutrophil/lymphocyte ratios are also positively correlated with indeterminate QuantiFERON-TB gold (16). In areas of low risk and low prevalence, the positive predictive value of any test is diminished. Of the 75 indeterminate test results, 73 (97.33%) were due to low mitogen (i.e., Phytohaemagglutinin) response, with IFN- less than 0.5 IU mL -1. We observed that patients with negative and weak mitogen responses have similar characteristics, especially for immunodepression status, which was identified in, respectively, 58 and 52% of these patients, compared with 36% of patients with normal response. We thank the patients, Jean-Baptiste Bour (for his invaluable help in conducting this study) and the technicians from the virology laboratory, Maud Carpentier from the DRCI (Direction de la Recherche Clinique et de lInnovation), Emmanuel Florentin for the extraction of biological data, Aurlie Bertaut, Olivera Buirey and Julie Gentil from the CGFL, and Suzanne Rankin for proofreading and editing the manuscript. This page was last edited on 20 February 2023, at 09:25. 702-800-2723Fax: Furthermore, our data for patients with microbiologically confirmed TB are illustrative. Mitogen minus Nil (IU/ml) QFT -Plus Result Re sult interpretation 8.0 0.35 and 25% of Nil Any Any Positive M. tuberculosis infection likely Any 0.35 and 25% of Nil <0.35 or 0.35 and <25% of Nil <0.35 or 0.35 and <25% of Nil 0.50 Negative M. tuberculosis infection NOT likely <0.35 or 0.35 Order LOINC Value. In this case, generally, the test must be retaken with a fresh blood sample. False Discovery Rate post hoc correction for multiple comparisons was used and P value reported in the figure : *P < 0.05; **P < 0.01. 11 0 obj <> endobj [The clinical application of quantiferon TB-2G: its usefulness and limitations]. (2018) 31:e2118. The second one, 5 weeks after the start of antimycobacterial treatment, was positive (Ag TB-Nil [IFN-] = 3.86 IU/mL). Normal range/expected value(s) for a specific disease state. QuantiFERON-TB gold tests were performed by the same laboratory (virology laboratory of the Dijon University Hospital) according to manufacturer instructions. Am J Respir Crit Care Med. There were 252 (46.15%) negative, 219 (40.10%) positive and 75 (13.73%) indeterminate test results. In the United States, the test is widely available from state public health laboratories, hospitals, and commercial laboratories. Martin MD, Badovinac VP, Griffith TS. It may render inaccurate results for people who were recently exposed to TB. Briefly, four blood collection tubes were drawn: TB1, TB2, and controls (nil and mitogen). In a study of military personnel returning from missions, about one-half of the positive TSTs were falsely positive. Cases were defined as patients with a negative mitogen response, (IFN- 0.5 IU/ml), as defined by the commercial supplier, or with a weak mitogen response (IFN- = 0.52 IU/ml). Data were collected from the 3 groups of patients constituted, namely the cases (all the patients with a negative or a weak mitogen response) and the control patients (1 control patient/case with a normal mitogen response). A total of 872 patients were included. (2005) 44:561-71. Royston P, Sauerbrei W. Building multivariable regression models with continuous covariates in clinical epidemiologywith an emphasis on fractional polynomials. Storage/Transport: Maintain tubes at room temperature (22C 5C). (2014) 189:77-87. doi: 10.1164/rccm.201302-0365OC, 10. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. Hirsch CS, Toossi Z, Othieno C, Johnson JL, Schwander SK, Robertson S, et al. Front Immunol. The .gov means its official. When considering only clinical variables, multivariable analysis revealed that an ongoing infection at the time of QFT was independently associated with both a negative (negative vs. normal RR = 4.34; 95% CI = 2.946.41), and a weak mitogen response (weak vs. normal RR = 2.44; 95% CI = 1.663.58), as well as older age and immunodepression. 500 East Windmill Lane, The exhaustion of T lymphocytes is a well-known consequence of sepsis (23) and other chronic infections such as TB (17, 24), minimizing the damage to host tissue related to inflammatory response (25). 0000006042 00000 n [4][5] However, one of the five sites involved in the CDC study reported less agreement. Post-hoc 2 2 comparisons were performed using the Wilcoxon Mann-Whitney test and Chi-square test as appropriate. Hradsky O, Ohem J, Zarubova K, Mitrova K, Durilova M, Kotalova R, et al. CD4 T cell responses and the sepsis-induced immunoparalysis state. Jeon YL, Nam Y, You E, Yang JJ, Kim MJ, Cho SY, et al. Accessibility, SCHEDULE 1 HOUR FDA AUTHORIZED COVID-19 PCR TESTING, Order 1 Hour FDA Authorized Covid-19 PCR Testing, Legal, Court Ordered, Probation, DUI or Child Custody Drug Testing, Outcomes of The Anti-Vaccination Movement. (2019) 158:49-54. doi: 10.1016/j.rmed.2019.10.004, Keywords: QuantiFERON, mitogen, infection, outcomes, mortality, Citation: Jacquier M, Binquet C, Manoha C, Audia S, Simonet-Lamm A-L, Casenaz A, Sow A-K, Piroth L and Blot M (2022) Beyond QuantiFERON-TB Results, the Added Value of a Weak Mitogen Response. A prospective analysis of lymphocyte phenotype and function over the course of acute sepsis. Drain PK, Bajema KL, Dowdy D, Dheda K, Naidoo K, Schumacher SG, et al. PLoS One. QuantiFERON Mitogen Value test cost is between $149.00 and $535.99. Eur Respir J. Brown J, Kumar K, Reading J, Harvey J, Murthy S, Capocci S, et al. Positive or Abnormal. Clin Microbiol Rev. How it could be impacted and associated with outcomes is poorly known. 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