Evaluation of serum inflammatory biomarkers as predictors of treatment outcome in pulmonary tuberculosis

A. Singanayagam (Lead / Corresponding author), K. Manalan, D. W. Connell, J. D. Chalmers, S. Sridhar, A. I. Ritchie, A. Lalvani, M. Wickremasinghe, O. M. Kon

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Abstract

Objective: To evaluate C-reactive protein (CRP), globulin and white blood cell (WBC) count as predictors of treatment outcome in pulmonary tuberculosis (PTB).

Methods: An observational study of patients with active PTB was conducted at a tertiary centre. All patients had serum CRP, globulin and WBC measured at baseline and at 2 months following commencement of treatment. The outcome of interest was requirement for extension of treatment beyond 6 months.

Results: There were 226 patients included in the study. Serum globulin 45 g/l was the only baseline biomarker evaluated that independently predicted requirement for treatment extension (OR 3.42, 95%CI 1.597.32, P 0.001). An elevated globulin level that failed to normalise at 2 months was also associated with increased requirement for treatment extension (63.9% vs. 5.1%, P 0.001), and had a low negative likelihood ratio (0.07) for exclusion of requirement for treatment extension. On multivariable analysis, an elevated globulin that failed to normalise at 2 months was independently associated with requirement for treatment extension (OR 6.13, 95%CI 2.2316.80, P 0.001).

Conclusions: Serum globulin independently predicts requirement for treatment extension in PTB and outperforms CRP and WBC as a predictive biomarker. Normalisation of globulin at 2 months following treatment commencement is associated with low risk of requirement for treatment extension.

Original languageEnglish
Pages (from-to)1653-1660
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Volume20
Issue number12
DOIs
Publication statusPublished - 1 Dec 2016

Keywords

  • Biomarker
  • Outcome
  • Tuberculosis

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