A simple-to-use nomogram for the individualized prediction of multidrug-resistant tuberculosis among individuals with previous tuberculosis history

Abstract Background: So far, there are few studies that have investigated the risk of incident multidrug-resistant tuberculosis (MDR-TB) among individuals with previous tuberculosis history (PTBH), let alone developed a nomogram so as to comprehensively estimate an individualized risk of incident MDR-TB in this population. The present study was to construct a comprehensive nomogram for providing simple and precise personalized prediction of incident MDR-TB risk among individuals with PTBH. Methods: A matched case−control study (1: 2 ratios) was performed between 2005 and 2018 in Hangzhou City, China. A multivariable Cox proportional hazard regression was used to evaluate independent predictors of incident MDR-TB in individuals with PTBH. A comprehensive nomogram was developed based on the multivariable Cox model. Results: Overall, 1, 836 participants were included in this study. We developed a simple-to-use nomogram for predicting the individualized risk of incident MDR-TB by using the parameters of age < 60 years, a history of direct contact, passive mode of TB case finding, human immunodeficiency virus infection, re-treated TB history, unsuccessful treatment, 3HRZES/6HRE, duration of pulmonary cavities, and duration of positive sputum culture in individuals with PTBH. The concordance index of this nomogram was 0.833 [95% confidence interval (CI): 0.807-0.859] and 0.871 (95% CI 0.773-0.969) for the training and validation sets, respectively, which indicated adequate discriminatory power. The calibration curves for the risk of incident MDR-TB showed an optimal agreement between nomogram prediction and actual observation in the training and validation sets, respectively. The high sensitivity and specificity of nomogram was indicated by using a receiver operating characteristic curve analysis. Conclusions: We developed and validated a novel nomogram for predicting and preventing the risk of incident MDR-TB in individuals with PTBH. Through this clinic tool, TB control executives could more precisely monitor, estimate and intervene the risk of incident MDR-TB among individual PTB patients.