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Sedimentation rate and suPAR in relation to disease activity and mortality in patients with tuberculosis

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OBJECTIVE: To investigate how levels of the soluble urokinase plasminogen activator receptor (suPAR) and erythrocyte sedimentation rate (ESR) correlate with disease activity and prognosis in pulmonary tuberculosis (PTB).

DESIGN: This was a retrospective analysis of patients with active PTB (n = 500) in Gondar, Ethiopia, for whom the suPAR (n = 301) and ESR (n = 330) were analysed at the start of treatment. Both biomarkers were available for 176 patients. Human immunodeficiency virus (HIV) status, chest X-ray (CXR) findings, classification according to the clinical TBscore and treatment outcome were all recorded.

RESULTS: In a multivariable logistic regression analysis adjusted for age, sex and HIV status, surrogate markers of disease activity such as advanced CXR patterns correlated with increased levels of suPAR (adjusted OR [aOR] 8.24, P < 0.001) and of ESR (aOR 1.63, P = 0.030), whereas ESR only correlated significantly with a TBscore >6 points. Increased levels of both suPAR and ESR were associated with unsuccessful treatment outcomes (aOR 2.93, P = 0.013; aOR 2.52, P = 0.025). The highest quartile of suPAR (aOR 13.3, P = 0.029) but not ESR levels correlated independently with increased mortality.

CONCLUSION: SuPAR and ESR levels correlate with disease activity in PTB; however, the clinical role of these potentially prognostic biomarkers needs to be verified in prospective studies.
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Keywords: HIV; TBscore; biomarkers; chest X-ray; outcome

Document Type: Research Article

Affiliations: 1: Department of Infectious Diseases, Linköping University Hospital, Linköping 2: Department of Infectious Diseases, Linköping University Hospital, Linköping, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden 3: Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopian Public Health Institute, Addis Ababa, Ethiopia 4: Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation, Linköping University 5: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden 6: Department of Clinical Physiology, Kalmar County Hospital, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden 7: Department of Internal Medicine, University of Gondar, Gondar 8: Department of Radiology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia 9: Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden 10: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau, Department of Infectious Diseases, Aarhus University Hospital, Aarhus, GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark 11: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation, Linköping University 12: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation, Linköping University, Department of Infectious Diseases and Clinical Microbiology, Kalmar County Hospital, Linköping University, Linköping, Sweden

Publication date: November 1, 2019

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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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