{"doi":"10.1093/cid/ciab598","title":"A Clinical Prediction Model for Unsuccessful Pulmonary Tuberculosis Treatment Outcomes","abstract":"BACKGROUND: Despite widespread availability of curative therapy, tuberculosis (TB) treatment outcomes remain suboptimal. Clinical prediction models can inform treatment strategies to improve outcomes. Using baseline clinical data, we developed a prediction model for unsuccessful TB treatment outcome and evaluated the incremental value of human immunodeficiency virus (HIV)-related severity and isoniazid acetylator status. METHODS: Data originated from the Regional Prospective Observational Research for Tuberculosis Brazil cohort, which enrolled newly diagnosed TB patients in Brazil from 2015 through 2019. This analysis included participants with culture-confirmed, drug-susceptible pulmonary TB who started first-line anti-TB therapy and had ≥12 months of follow-up. The end point was unsuccessful TB treatment: composite of death, treatment failure, regimen switch, incomplete treatment, or not evaluated. Missing predictors were imputed. Predictors were chosen via bootstrapped backward selection. Discrimination and calibration were evaluated with c-statistics and calibration plots, respectively. Bootstrap internal validation estimated overfitting, and a shrinkage factor was applied to improve out-of-sample prediction. Incremental value was evaluated with likelihood ratio-based measures. RESULTS: Of 944 participants, 191 (20%) had unsuccessful treatment outcomes. The final model included 7 baseline predictors: hemoglobin, HIV infection, drug use, diabetes, age, education, and tobacco use. The model demonstrated good discrimination (c-statistic = 0.77; 95% confidence interval, .73-.80) and was well calibrated (optimism-corrected intercept and slope, -0.12 and 0.89, respectively). HIV-related factors and isoniazid acetylation status did not improve prediction of the final model. CONCLUSIONS: Using information readily available at treatment initiation, the prediction model performed well in this population. The findings may guide future work to allocate resources or inform targeted interventions for high-risk patients.","journal":"Clinical Infectious Diseases","year":2021,"id":165813,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":35,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9484,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":240239,"name":"Peter F. Rebeiro","orcid":"0000-0003-1951-9104","position":1,"is_corresponding":false},{"id":689802,"name":"Felipe Ridolfi","orcid":"0000-0002-3377-1026","position":2,"is_corresponding":false},{"id":252301,"name":"Bruno B. Andrade","orcid":"0000-0001-6833-3811","position":3,"is_corresponding":false},{"id":689803,"name":"Marcelo Cordeiro‐Santos","orcid":"0000-0002-7140-7145","position":4,"is_corresponding":false},{"id":110663,"name":"Afranio Kritski","orcid":"0000-0002-5900-6007","position":5,"is_corresponding":false},{"id":621331,"name":"Betina Durovni","orcid":"0000-0002-5555-8015","position":6,"is_corresponding":false},{"id":690316,"name":"Solange Calvacante","orcid":null,"position":7,"is_corresponding":false},{"id":689804,"name":"Marina C. Figueiredo","orcid":"0000-0002-0671-398X","position":8,"is_corresponding":false},{"id":292655,"name":"David W. 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