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Analysis of predictors influencing indeterminate whole-blood interferon-gamma release assay results in patients with rheumatic diseases

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Abstract

Triggers of indeterminate results from interferon-gamma release assays (IGRA) in patients with rheumatic diseases are still elusive. The aim of the present study was to describe predictors of indeterminate results from IGRA in the field of rheumatology. This cross-sectional study was retrospectively performed by using a database of patients with a request for QuantiFERON-TB Gold-In Tube test (QFT-GIT) for screening of latent tuberculosis infection. The study cohort included 631 patients with rheumatic diseases. All variables influencing indeterminate QFT-GIT results were investigated by logistic regression analysis. The overall frequency of indeterminate IGRA results was 6.8 % (43/631). Those with indeterminate results were more likely to be aged ≥70 years, female, visitors in winter, suffering from systemic lupus erythematosus (SLE), and using sulfasalazine or a tumor necrosis factor (TNF)-α inhibitor. In addition, a longer incubation time of >6 h increased the odds ratio of indeterminate IGRA results. In contrast, the automated ELISA processor, ankylosing spondylitis, and the use of a non-steroidal anti-inflammatory drug decreased the likelihood of indeterminate IGRA results. Lymphopenia, thrombocytopenia, anemia, and hypoalbuminemia were significantly associated with indeterminate IGRA results. Multivariate analysis revealed that SLE, use of sulfasalazine or a TNF-α inhibitor, and a manual ELISA system were significantly independent predictors of indeterminate IGRA results. The proportion of indeterminate results in patients with rheumatic diseases is not infrequent. Careful attention to the pre-analytical conditions should minimize the indeterminate results. Automation of the ELISA process seems to be a promising solution to decrease the rate of indeterminate response.

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Acknowledgments

The authors thank Dr. Min-Ho Shin (Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea) for the statistical assistance. This study was supported by grants from the National Research Foundation of Korea Grant funded by the Korean Government (Grants 2011-0012365, 2011-0011332, and 2013R1A2A2A01067956).

Conflict of interest

The authors have declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Rheumatology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, Republic of Korea

    Hyun-Ju Jung, Tae-Jong Kim, Hyoung-Sang Kim, Young-Nan Cho, Hye-Mi Jin, Moon-Ju Kim, Jeong-Hwa Kang, Ki-Jeong Park, Sung-Ji Lee, Shin-Seok Lee & Yong-Wook Park

  2. Department of Pulmonary and Critical Care Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea

    Yong-Soo Kwon

  3. Department of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Republic of Korea

    Dae-Hyun Yoo

  4. Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, Republic of Korea

    Seung-Jung Kee

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  1. Hyun-Ju Jung
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  2. Tae-Jong Kim
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  13. Seung-Jung Kee
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  14. Yong-Wook Park
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Corresponding authors

Correspondence to Seung-Jung Kee or Yong-Wook Park.

Additional information

H.-J. Jung and T.-J. Kim contributed equally to this work.

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Jung, HJ., Kim, TJ., Kim, HS. et al. Analysis of predictors influencing indeterminate whole-blood interferon-gamma release assay results in patients with rheumatic diseases. Rheumatol Int 34, 1711–1720 (2014). https://doi.org/10.1007/s00296-014-3033-z

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  • DOI: https://doi.org/10.1007/s00296-014-3033-z

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