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Deprecated: Implicit conversion from float 263.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Medicine+(Baltimore) 2015 ; 94 (39): ä Nephropedia Template TP
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Plasma Biomarkers Can Predict Treatment Response in Tuberculosis Patients: A Prospective Observational Study #MMPMID26426648
Lee MR; Tsai CJ; Wang WJ; Chuang TY; Yang CM; Chang LY; Lin CK; Wang JY; Shu CC; Lee LN; Yu CJ
Medicine (Baltimore) 2015[Sep]; 94 (39): ä PMID26426648show ga
Despite numerous studies, there has been little progress in the use of biomarkers for predicting treatment response in patients with tuberculosis (TB).Patients with culture-confirmed pulmonary TB between 2010 and 2014 were prospectively recruited. Blood samples were taken upon diagnosis and 2 months after the start of standard anti-TB treatment. A pilot study utilizing measurement of TB-antigen-stimulated cytokines was conducted to select potential biomarkers for further testing. Outcome was defined as persistent culture positivity at 2 months into treatment.Of 167 enrolled patients, 26 had persistent culture positivity. RANTES, IL-22, MMP-8, IL-18, MIG, and Granzyme A were selected as potential biomarkers. For predicting persistent culture positivity, receiver-operating characteristics (ROC) analysis showed that initial RANTES (AUC: 0.725 [0.624?0.827]) and 2-month MMP-8 (AUC: 0.632 [0.512?0.713]) had good discriminative ability. Using a logistic regression model, low initial RANTES level (<440?pg/mL), initial smear positivity, and high 2-month MMP-8 level (>3000?pg/mL) were associated with persistent culture positivity. Low initial RANTES level and initial smear positivity had a positive predictive value of 60% (12/20) for persistent culture positivity, compared with 4% (3/75) among patients with high RANTES level and smear negativity upon diagnosis. In the 72 patients with either low RANTES/smear negativity or high RANTES/smear positivity upon diagnosis, the 2-month MMP-8 level had a positive and negative predictive value of 24 and 94%, respectively, for 2-month culture status.Aside from an initial sputum smear status, serum RANTES level at diagnosis and MMP-8 level at 2 months of treatment may be used to stratify risk for culture persistence.