ABSTRACT
Background: Anemia leads to a lower cure rate and poor prognosis in tuberculosis patients. Effective predictors for the prognosis of tuberculosis with anemia (A-TB) are urgently needed. Monocyte has been proven to be a prognostic biomarker of many lung diseases. Whether monocyte that the predominant innate immune cell as early defense against tuberculosis can predict A-TB is not known. Methods: Data for A-TB patients with initial treatment in Shanghai Pulmonary Hospital were retrospectively collected and analyzed. Logistics regression analysis was used to study the correlation between peripheral blood cells and treatment outcomes. The receiver operating characteristic (ROC) curve was used to determine the cut-off value. We estimated a 12-month prognosis using Kaplan-Meier techniques. The Cox proportional hazards model was used for the univariate and multivariate analyses to analyze the predictors of poor prognosis of A-TB. Results: Of 181 patients analyzed, 94 were cured and 87 non-cured. Logistic regression analysis identified monocyte as an independent immune-related risk factor for the prognosis of A-TB (OR: 7.881, 95% CI: 1.675-37.075, P = 0.009). The ROC curve analysis proved that the most discriminative cut-off value of monocyte was 0.535 × 10^9/L. K-M analysis demonstrated that the cumulative cure rates of A-TB were significantly higher in A-TB with monocyte < 0.535 × 10^9/L (69.62%) than that in those with monocyte ≥ 0.535 × 10^9/L (38.24%) (Log-rank, χ2 = 16.530, P < 0.0001). On univariate and multivariable analysis, monocyte was an independent predictor of poor prognosis in A-TB. Similarly, monocyte was also an independent predictor of poor pulmonary cavity closure in A-TB (HR: 3.614, 95% CI: 1.335-9.787, P = 0.011). Conclusion: In A-TB patients, elevated monocyte was associated with poor prognosis and poor cavity pulmonary closure. Monocyte may provide a simple and inexpensive prognostic biomarker in A-TB.
ABSTRACT
Background: Anemia is one of the risk factors for tuberculosis (TB), and more than 90% of TB patients suffer from anemia. The majority tuberculosis patients who had poor prognosis experienced anemia during the course of treatment. The objective of our study is to analyse the influences of anemia on the prognosis of tuberculosis patients in terms of pulmonary M. tuberculosis loads, lung pathology, and clinical factors. Methods: In this retrospective cohort study, 155 TB patients in Shanghai were divided into the anemia-tuberculosis (A-TB) group and non-anemia-tuberculosis (NA-TB) group. We analysed bacteria counts in sputum smear and sputum smear conversion time between two groups. We evaluated the pulmonary pathology of cavity and effusion in A-TB patients. Logistic regression analysis was performed to explore the potential correlations of anemia with sputum bacterial load and pulmonary pathology. We compared clinical factors including the immune factors and inflammatory cells. Results: Compared with the NA-TB (n=89) group, the A-TB group (n=66) had poorer improvement of lung injury in terms of cavity closure (4.7±3.59 vs. 10.56±7.42; P=0.036) and fluid improvement [4 (30.77%) vs. 12 (92.31%); P=0.001] during conventional treatment. At the start of treatment, the immune factors complement 4 (C4) [0.25 (0.19, 0.295) vs. 0.3086±0.076; P=0.006] and C-reactive protein (CRP) [3.2 (3.2, 21.5) vs. 19.5 (6.25, 78.35); P=0.016] were significantly higher in A-TB with NA-TB. During the course of treatment, the gradual decrease in the absolute number of lymphocytes (LYM#) (P=0.0012, r=-0.3400) and the gradual increase in the absolute number of monocytes (MONO#) (P=0.0050, r=0.2968), the absolute number of basophils (BASO#) (P=0.0213, r=0.2451), the red blood cell distribution width-coefficient (RDW-CV) (P=0.0136, r=0.2651), suggesting poor prognosis in anemic TB patients. Conclusions: Anemia is a risk factor for lung injury in TB patients. Inflammatory factors and inflammatory cells are increased during treatment in A-TB patients.