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Free Content Tuberculosis case finding and mortality prediction: added value of the clinical TBscore and biomarker suPAR

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SETTING: A suburban area of Bissau, the capital of Guinea-Bissau; the study was conducted among presumptive pulmonary tuberculosis (prePTB) patients seeking medical care for signs and symptoms suggestive of PTB.

OBJECTIVE: To determine if a clinical TB score and a biomarker suPAR (soluble urokinase plasminogen activator receptor) have separate and composite ability to predict PTB diagnosis and mortality in prePTB patients.

DESIGN: Observational prospective follow-up study conducted from August 2010 to August 2012.

RESULTS: We included 1011 prePTB patients (mean age 34 years, 95%CI 33–35); 55% (n = 559) were female and 161 (16%) had human immunodeficiency virus (HIV) infection. Of all included patients, 10% (n = 101) were diagnosed with PTB. Mortality during follow-up was 5% (n = 48), with a mean survival time of 158 days (95%CI 27–289) in prePTB patients diagnosed with PTB vs. 144 days (95%CI 109–178) in those not diagnosed with PTB (P = 0.774). After adjusting for HIV status and age, the best separate predictor was suPAR 5 ng/ml, with a hazard ratio (HR) of 4.6 (95%CI 2.1–9.9) for mortality and 6.7 (95%CI 4.0–11.2) for TB diagnosis. All patients who died had a TBscore II + suPAR 7; the HR of the composite score for subsequent PTB diagnosis was 33.0 (95%CI 4.6–236.6).

CONCLUSION: The proposed composite score of suPAR + TBscore II 7 can improve TB case finding and clinical monitoring.
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Keywords: biomarker; case finding; clinical score; mortality prediction; tuberculosis

Document Type: Research Article

Affiliations: 1: Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Center for Global Health, School of Public Health, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark 2: Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau 3: Department of Infectious Diseases, Aarhus University Hospital, Aarhus 4: Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark

Publication date: 2017-01-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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