A blood-based 3-gene signature score for therapeutic monitoring in patients with pulmonary tuberculosis

IF 2.8 3区医学 Q3 IMMUNOLOGY Tuberculosis Pub Date : 2024-05-23 DOI:10.1016/j.tube.2024.102521

Peize Zhang , Junfeng Zheng , Tingting Han , Jian Ma , Devasena Gnanashanmugam , Mengran Li , Yi-Wei Tang , Guofang Deng

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Abstract

Objective

To assess the validity of Xpert Tuberculosis Fingerstick score for monitoring treatment response and analyze factors influencing its performance.

Methods

122 adults with pulmonary tuberculosis were recruited and stratified into three cohorts: Diabetic-drug-susceptible-TB (DM-TB), Non-diabetic-drug-susceptible-TB (NDM-TB) and Non-diabetic Multidrug-resistant TB (MDR-TB). Fingerstick blood specimens were tested at treatment initiation (M0) and the end of the first (M1), second (M2), and sixth month (M6) to generate a TB-score.

Results

The TB-score in all participants yielded an AUC of 0.707 (95% CI: 0.579–0.834) at M2 when its performance was evaluated against sputum culture conversion. In all non-diabetes patients, the AUC reached 0.88 (95% CI: 0.756–1.000) with an optimal cut-off value of 1.95 at which sensitivity was 90.0% (95% CI: 59.6–98.2%) and specificity was 81.3% (95% CI: 70.0–88.9%). The mean TB score was higher in patients with low bacterial loads (n = 31) than those with high bacterial loads (n = 91) at M0, M1, M2, and M6, and was higher in non-cavitary patients (n = 71) than those with cavitary lesions (n = 51) at M0, M1, and M2.

Conclusion

Xpert TB-score shows promising predictive value for culture conversion in non-diabetic TB patients. Sputum bacterial load and lung cavitation status have an influence on the value of TB score.

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用于肺结核患者治疗监测的基于血液的 3 基因特征评分

方法招募了 122 名成人肺结核患者，并将其分为三个组群：糖尿病药物敏感型肺结核（DM-TB）、非糖尿病药物敏感型肺结核（NDM-TB）和非糖尿病耐多药肺结核（MB-TB）：方法招募了 122 名成人肺结核患者，并将其分为三组：糖尿病药物敏感型肺结核（DM-TB）、非糖尿病药物敏感型肺结核（NDM-TB）和非糖尿病耐多药肺结核（MDR-TB）。在开始治疗时（M0）、第一个月末（M1）、第二个月末（M2）和第六个月末（M6），对指血标本进行检测，以得出肺结核评分。结果在 M2 时，所有参与者的肺结核评分与痰培养转化率的 AUC 值为 0.707（95% CI：0.579-0.834）。在所有非糖尿病患者中，AUC 达到 0.88（95% CI：0.756-1.000），最佳临界值为 1.95，此时敏感性为 90.0%（95% CI：59.6-98.2%），特异性为 81.3%（95% CI：70.0-88.9%）。在 M0、M1、M2 和 M6 阶段，低细菌量患者（n = 31）的平均 TB 评分高于高细菌量患者（n = 91），在 M0、M1 和 M2 阶段，非空洞型患者（n = 71）的平均 TB 评分高于空洞型病变患者（n = 51）。痰中细菌量和肺空洞状态对 TB 评分的价值有影响。

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来源期刊

Tuberculosis 医学-呼吸系统

CiteScore

4.60

自引率

3.10%

发文量

审稿时长

49 days

期刊介绍： Tuberculosis is a speciality journal focusing on basic experimental research on tuberculosis, notably on bacteriological, immunological and pathogenesis aspects of the disease. The journal publishes original research and reviews on the host response and immunology of tuberculosis and the molecular biology, genetics and physiology of the organism, however discourages submissions with a meta-analytical focus (for example, articles based on searches of published articles in public electronic databases, especially where there is lack of evidence of the personal involvement of authors in the generation of such material). We do not publish Clinical Case-Studies. Areas on which submissions are welcomed include: -Clinical TrialsDiagnostics- Antimicrobial resistance- Immunology- Leprosy- Microbiology, including microbial physiology- Molecular epidemiology- Non-tuberculous Mycobacteria- Pathogenesis- Pathology- Vaccine development. This Journal does not accept case-reports. The resurgence of interest in tuberculosis has accelerated the pace of relevant research and Tuberculosis has grown with it, as the only journal dedicated to experimental biomedical research in tuberculosis.