High rate of indeterminate results of the QuantiFERON-TB Gold in-tube test, third generation, in patients with systemic vasculitis. (13th September 2019)

• Record Type: Journal Article
• Authors: Rousset, Stella; Treiner, Emmanuel; Moulis, Guillaume; Pugnet, Grégory; Astudillo, Léonardo; Paricaud, Kim; Puissant-Lubrano, Bénédicte; Arlet, Philippe; Blancher, Antoine; Sailler, Laurent
• Is Part Of: Rheumatology. Volume 59:Number 5(2020)
• Page Start: 1006
• Page End: 1010
• Publication Date: 2019-09-13
• Subjects: interferon gamma release assay -- QuantiFERON -- latent tuberculosis infection -- indeterminate results -- systemic vasculitis -- giant cell arteritis; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/kez390
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: To describe the frequency of QuantiFERON-TB Gold in-tube test® (QFT-GIT) indeterminate results due to no response to phytohaemagglutinin A stimulation in the control tube in vasculitis patients prior to immunosuppressant therapy; and to compare it with other groups of patients. Methods: This was a single-centre, retrospective study. Patients and controls were included between 1 January 2008 and 31 December 2015. We assessed the rate of indeterminate results of the QFT-GIT in 38 patients with systemic vasculitis prior to any corticosteroid or immunosuppressant therapy, compared with 40 non-vasculitis patients with biological inflammatory syndrome, and 310 non-immunosuppressed patients matched for gender and age. Results: Indeterminate results due to no response to phytohaemagglutinin A were more frequent in vasculitis patients (21.1%) compared with non-vasculitis patients with biological inflammatory syndrome (7.5%) (Fisher's exact test: P = 0.11) and to anonymized controls (7%) ( P = 0.009). Responses to phytohaemagglutinin A were significantly lower in vasculitis patients compared with other groups (Kruskal–Wallis test: P < 0.0001) and compared with non-vasculitis patients with biological inflammatory syndrome ( P = 0.0015). The multivariable analysis identified as independent predictors of an indeterminate result of the QFT-GIT: the presence of systemic vasculitis (odds ratio 9.64 [1.14–81.3], P = 0.037) and a high neutrophil-to-lymphocyte ratio (odds ratio 1.70 [1.21–2.37], P = 0.002). One patient with an indeterminate result of QFT-GIT developed active tuberculosis after one year of corticosteroid therapy for giant cell arteritis. Conclusion: Our results question the reliability of QFT-GIT to rule out latent tuberculosis in vasculitis patients at diagnosis, prior to immunosuppressant therapy.