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Vidyasagaran AL, Readshaw A, Boeckmann M, Jarde A, Siddiqui F, Marshall AM, Akram J, Golub JE, Siddiqi K, Dogar O. Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis. Chest 2024; 165:22-47. [PMID: 37652295 PMCID: PMC10790178 DOI: 10.1016/j.chest.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/20/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically. RESEARCH QUESTION Is tobacco use associated with risk of poor treatment outcomes among people with TB? STUDY DESIGN AND METHODS The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively. RESULTS Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I2 = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I2 = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I2 = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I2 = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I2 = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it. INTERPRETATION Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes. TRIAL REGISTRY PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, England; Yorkshire and North Lincolnshire Area Team, Natural England
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Alexander Jarde
- Université de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, and Cochrane France, Paris, France
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York, England
| | - Anna-Marie Marshall
- Department of Health Sciences, University of York, York, England; Research Fellow in Public Health and lecturer in Public Health and Psychology, Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, England
| | - Janita Akram
- Hull York Medical School, University of York, York, England
| | - Jonathan E Golub
- Center for Tuberculosis Research, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, England; Hull York Medical School, University of York, York, England
| | - Omara Dogar
- Department of Health Sciences, University of York, York, England; Usher Institute, The University of Edinburgh, Edinburgh, Scotland.
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Shojaan H, Kalami N, Ghasempour Alamdari M, Emami Alorizy SM, Ghaedi A, Bazrgar A, Khanzadeh M, Lucke-Wold B, Khanzadeh S. Diagnostic value of the neutrophil lymphocyte ratio in discrimination between tuberculosis and bacterial community acquired pneumonia: A meta-analysis. J Clin Tuberc Other Mycobact Dis 2023; 33:100395. [PMID: 37692090 PMCID: PMC10485633 DOI: 10.1016/j.jctube.2023.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Background We conducted a systematic review and meta-analysis, based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, to evaluate current literature on diagnostic value of neutrophil to lymphocyte ratio (NLR) in discrimination between tuberculosis (TB) and bacterial community acquired pneumonia (B-CAP). Methods Literature search was conducted from July 20, 2023 using Scopus, PubMed, and Web of Science databases. STATA software (version 12.0; Stata Corporation) was used for all analyses. Results We found that patients with TB had significantly lower levels of NLR compared to those with B-CAP (SMD = -1.09, 95 %CI = -1.78- -0.40, P = 0.002). In the quality subgroup analysis, we found that patients with TB had significantly lower level of NLR compared to those with B-CAP consistent in moderate (SMD = -0.86, 95 %CI = -2.30, 0.57, P = 0.23) and high-quality studies (SMD = -1.25, 95 %CI = -2.07, -0.42). In the subgroup analysis based on continent, we found that patients with TB had significantly lower level of NLR compared to those with B-CAP in studies performed in Asian populations (SMD = -1.37, 95 %CI = -2.13, -0.61, P < 0.001), but not on African population (SMD = -0.02, 95 %CI = -1.06, 1.02, P = 0.97). The result of this study did not change after execution of sensitivity analysis. The pooled sensitivity of NLR was 0.86 (95% CI = 0.80, 0.91), and the pooled specificity was0.88 (95% CI = 0.69, 0.95). Conclusion Patients with TB had a significantly lower NLR levels compared to those with B-CAP, so we utilized this biomarker for distinguishing between the disorders.
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Affiliation(s)
- Horieh Shojaan
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Niusha Kalami
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Monireh Khanzadeh
- Geriatric & Gerontology Department, Medical School, Tehran University of Medical and Health Sciences, Tehran, Iran
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Sugiura Y, Nakamura M, Fujimoto H, Ochiai H, Ohkubo Y, Fusegawa H, Kawai O, Araki N, Hashizume T. An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula. Gen Thorac Cardiovasc Surg 2023; 71:657-664. [PMID: 37002472 DOI: 10.1007/s11748-023-01933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Some surgical cases of pleural empyema lead to death despite multidisciplinary treatment. The purpose of this study was to identify prognostic factors in cases treated surgically for pneumonia-associated pleural effusions and empyema caused by common bacteria. METHODS We conducted a retrospective cohort study of 108 surgical patients of empyema who encountered at our hospital between 2011 and 2021. Patients were divided into surviving and non-surviving cases. Factors on admission (age, sex, body mass index, presence of fistula, performance status, pleural fluid culture results, HbA1c, albumin, leukocytes, hemoglobin, body temperature, heart rate, respiratory rate, systolic blood pressure, prognostic nutritional index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and RAPID score) were compared between the two groups. RESULTS There were 87 cases of pleural empyema caused by pneumonia due to common bacteria. Variables that differed significantly in univariate analysis between the surviving and non-surviving cases in patients' characteristics on admission were fistula (p value < 0.001, odds ratio 20.000, 95% confidence interval 3.478-115.022), positive pleural fluid culture (0.016, 6.591, 1.190-36.502), body mass index < 18.5 (0.001, 16.857, 1.915-148.349), performance status 0-1 (0.007, 11.778, 1.349-102.858), and hemoglobin (0.024, 1.768, 1.077-2.904). Multivariate analysis showed significant differences in the presence of fistula (p = 0.036, CI 1.174-125.825). The odds ratio was 12.154. The mortality rate was 3.8% for non-fistulous empyema and 44.4% for fistulous empyema. In 6 of 9 cases of fistulous empyema, the fistula could be closed. CONCLUSION Fistula was a significant independent prognostic factor for pneumonia-associated pleural effusions and empyema caused by common bacteria.
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Affiliation(s)
- Yasoo Sugiura
- Department of General Thoracic Surgery, National Hospital Organization, Kanagawa National Hospital, 666-1 Ochiai Hadano, Kanagawa, 257-8585, Japan.
| | - Morio Nakamura
- Department of Respiratory Medicine, National Hospital Organization, Kanagawa National Hospital, Kanagawa, Japan
| | - Hiroyuki Fujimoto
- Department of General Thoracic Surgery, National Hospital Organization, Kanagawa National Hospital, 666-1 Ochiai Hadano, Kanagawa, 257-8585, Japan
| | - Hiroko Ochiai
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yasuyuki Ohkubo
- Department of Respiratory Medicine, National Hospital Organization, Kanagawa National Hospital, Kanagawa, Japan
| | - Hisae Fusegawa
- Department of Respiratory Medicine, National Hospital Organization, Kanagawa National Hospital, Kanagawa, Japan
| | - Osamu Kawai
- Department of Respiratory Medicine, National Hospital Organization, Kanagawa National Hospital, Kanagawa, Japan
| | - Norito Araki
- Department of Respiratory Medicine, National Hospital Organization, Kanagawa National Hospital, Kanagawa, Japan
| | - Toshinori Hashizume
- Department of General Thoracic Surgery, National Hospital Organization, Kanagawa National Hospital, 666-1 Ochiai Hadano, Kanagawa, 257-8585, Japan
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Chai B, Wu D, Fu N, Huang P, Shen Y, Li Y, Wang Y. Evaluation of prognostic inflammatory and systemic inflammatory response indices in auxiliary diagnosis of bacteria-negative pulmonary tuberculosis: A diagnostic accuracy study. Medicine (Baltimore) 2023; 102:e33372. [PMID: 36961144 PMCID: PMC10036059 DOI: 10.1097/md.0000000000033372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
Although molecular biology has made great progress in recent years, the detection rate of mycobacterium tuberculosis (MTB) is still not ideal. This study aimed to evaluate the role of prognostic inflammatory index (PII) and systemic inflammatory response index (SIRI) in the auxiliary diagnosis of bacteria-negative pulmonary tuberculosis (TB). Sixty patients diagnosed with bacteria-negative pulmonary TB at the Affiliated Hospital of Qinghai University between October 2019 and September 2022 were randomly selected as the case group, and seventy patients with nontuberculous pulmonary infection in the same department of the same hospital during the same period were randomly selected as the control group. Baseline data and values of erythrocyte sedimentation rate (ESR), lymphocyte count (LY), neutrophil count (NE), monocyte count (MO), albumin (ALB), prealbumin (PA), C-reactive protein (CRP), fibrinogen (FIB), neutrophil-to-lymphocyte ratio (NLR), PII, and SIRI were compared between the 2 groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of PII and SIRI in the diagnosis of bacteria-negative pulmonary TB. No significant differences were found between the 2 groups in terms of sex and age (P > .05); however significant differences were observed in relation to body mass index (BMI), ESR, LY, NE, MO, ALB, PA, CRP, FIB, NLR, PII, and SIRI (P < .05). ROC curve analysis showed that area under curve (AUC) value {0.84 [95% CI (0.77, 0.90)]} and specificity {82.86% [95% CI (72.0, 90.8)]} of PII were the highest, while the sensitivity {86.67 [95% CI (75.4, 94.1)]} of NLR + PII was the highest. Pairwise comparison of the 7 indicators of ROC curve was performed, and only the diagnostic efficiency of NLR and NLR + PII was statistically significant (Z = 2.36, P = .02 < .05). NLR, PII, SIRI, pairwise combinations, and NLR + PII + SIRI showed auxiliary diagnostic values for bacteria-negative pulmonary TB, among which PII had the highest diagnostic value and specificity, while NLR + PII had the highest sensitivity.
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Affiliation(s)
| | - Dan Wu
- Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Na Fu
- Qinghai University, Xining, Qinghai, China
| | | | - Youlu Shen
- Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Yuhong Li
- Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Yinghong Wang
- Minle County People’s Hospital, Gansu, Zhangye, China
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Sugiura Y, Fujimoto H, Hashizume T. Multidisciplinary treatment of thoracic fistulous empyema caused by pulmonary infection: a retrospective study. Multidiscip Respir Med 2023; 18:926. [PMID: 38028375 PMCID: PMC10644305 DOI: 10.4081/mrm.2023.926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background In cases of thoracic empyema, the presence of a fistula is known to be difficult to treat and associated with a poor prognosis. Few reports have described the management of fistulous empyema caused by lung parenchymal infection. The aim of this study was to describe the outcomes of multidisciplinary management of fistulous empyema caused by pneumonia or lung abscess due to common bacteria and mycobacteria. Methods Among 108 cases of empyema surgically treated at Kanagawa Hospital over a 10-year period, 14 patients with fistulous empyema due to common bacteria (CBFE) or fistulous empyema due to mycobacteria (MFE) were analyzed. Fistulous empyema due to lung resection was excluded. Results Eight out of the 9 patients with CBFE and 4 out of the 5 patients with MFE were male. Patients with CBFE were more likely to be >65 years of age (p=0.052) and to have a poor performance status (p=0.078). The time from onset to first surgical treatment was significantly longer in MFE (median, 5 months; p=0.004). Five patients with CBFE and two patients with MFE underwent open window thoracostomy, while three patients with CBFE and four patients with MFE underwent endobronchial occlusion (EBO). Six patients (66%) with CBFE and 3 patients (60%) with MFE achieved fistula closure. Of the patients who underwent EBO, fistula closure was achieved in 3 (100%) of the patients with CBFE and in 2 (50%) of the patients with MFE. Fistula closure was not achieved in any case with non-tuberculous mycobacteria. Conclusions Fistulous empyema caused by common bacteria or Mycobacterium tuberculosis could be cured by surgical treatment and endobronchial intervention with adequate antimicrobial therapy, but fistulous empyema caused by non-tuberculous mycobacteria proved to be intractable. The challenge in the treatment of fistulous empyema due to non-tuberculous mycobacteria is the achievement of bacterial negativity.
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Affiliation(s)
- Yasoo Sugiura
- Department of General Thoracic Surgery, National Hospital Organization, Kanagawa National Hospital, Hadano, Japan
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Liu QX, Tang DY, Xiang X, He JQ. Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis. Front Cell Infect Microbiol 2022; 12:1013751. [PMID: 36506012 PMCID: PMC9731357 DOI: 10.3389/fcimb.2022.1013751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study was designed to assess and analyze nutritional status (NS) and immune status in patients with tuberculosis. Methods A retrospective analysis was conducted on 93 TB patients hospitalized in the tuberculosis ward of the West China Hospital of Sichuan University. Subgroup comparisons were made according to age (<65 years and ≥65 years), nutritional risk score 2002 (NRS 2002 <3 and ≥3), tuberculosis location [pulmonary tuberculosis and extrapulmonary tuberculosis (including pulmonary tuberculosis complicated with extrapulmonary tuberculosis)], and prognostic nutrition index (PNI) (<45 vs ≥45). Results Significantly increased weight loss was associated with extrapulmonary tuberculosis (P =0.0010). Serum albumin (P =0.0214), total lymphocyte count (P = 0.0009) and PNI (P = 0.0033) were significantly decreased in older patients. Neutrophils/lymphocytes (NLR) (P =0.0002), monocytes/lymphocytes (MLR) (P < 0.0001), and platelets/lymphocytes (PLR) (P =0.0107) were higher. According to NRS 2002, higher nutritional risk was associated with lower body weight and body mass index (BMI) (P < 0.0001), higher weight loss (P = 0.0012), longer duration of hospitalization (P =0.0100), lower serum albumin level and hemoglobin concentration (P <0.01), lower creatinine level, and lower PNI (P < 0.01). 0.0001), lower total lymphocyte count (P = 0.0004), higher neutrophil and monocyte counts (P <0.05), and higher NLR (P = 0.0002), MLR (P = 0.0006), and PLR (P = 0.0156). Lower PNI was associated with lower body weight (P = 0.0001) and BMI (P =0.0074), lower total protein, albumin, and hemoglobin concentrations (P < 0.0001), and lower total lymphocyte count (P < 0.0001) and creatinine levels (P = 0.0336), higher age (P =0.0002) and NRS 2002 score, P < 0.0001), longer hos-pital stay (P = 0.0003), higher neutrophil count (P = 0.0042), and NLR, MLR, and PLR (P <0.0001) were significantly correlated. In multivariate logistic regression analysis, weight loss (OR: 0.209, 95% CI: 0.060-0.722; p =0.013) was significantly associated with higher nutritional risk (NRS 2002≥3). In multiple linear regression analysis, the NRS 2002 score was higher (B=2.018; p =0.023), and extrapulmonary tuberculosis (B=-6.205; p =0.007) was linked with a longer duration of hos-pitalization. Conclusions Older tuberculosis patients are at nutritional risk, and older patients (≥65 years old) need to pay attention to nutritional monitoring and intervention. Older TB patients and those at risk of malnutrition have increased immune ratio and impaired immune function. Management of TB patients using basic diagnostic tools to assess nutritional and immune status and calculate PNI and immunological indexes (NLR, MLR, PLR) to improve treatment outcomes.
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Affiliation(s)
- Quan-Xian Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dao-Yan Tang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xi Xiang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
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Effect of Controlling Nutritional Status Score (CONUT) and Prognostic Nutritional Index (PNI) on patients after spinal tuberculosis surgery. Sci Rep 2022; 12:16056. [PMID: 36163373 PMCID: PMC9513047 DOI: 10.1038/s41598-022-19345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
The controlling nutritional status (CONUT) score and prognostic nutrition index (PNI) are immune-nutritional biomarkers that are related to clinical prognosis. Previous studies have reported using them to predict the prognosis of traumatic brain injury, tumours and other diseases. The purpose of this study was to evaluate the relationship between the PNI and CONUT score and the one-year prognosis of patients with spinal tuberculosis (STB). In this study, the clinical characteristics of 97 patients with STB who underwent debridement and internal fixation at our institution between 2015 and 2020 were retrospectively analysed. According to the receiver operating characteristic (ROC) curve, patients were divided into two groups: a high CONUT group and a low CONUT group. Patients were also divided into a high PNI group and a low PNI group. One-year postoperative prognosis was evaluated by the clinical cure standard. Patients in the favourable group were younger and had a lower rate of pneumonia and urinary tract infection, higher PNI and lower CONUT score than those in the favourable group (P < 0.05). There was an obvious correlation between the PNI and CONUT score (r = - 0.884, P < 0.05). The areas under the curve (AUCs) of the CONUT score and PNI for predicting unfavourable prognosis were 0.888 (95% CI 0.808-0.943, P < 0.001) and 0.896 (95% CI 0.818-0.949, P < 0.001), respectively. The adjusted odds ratios (ORs) of the CONUT score and PNI for predicting unfavourable outcomes were 2.447 (95% CI 1.518-4.043, P < 0.001) and 0.689 (95% CI 0.563-0.843, P < 0.001), respectively. Higher CONUT scores and a lower PNI were associated with adverse outcomes in patients with spinal tuberculosis, and the CONUT score and PNI might be independent predictors of adverse outcomes of spinal tuberculosis postoperatively.
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Suryana K, Dharmesti NWW, Rai IBN. High Pretreatment Level of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio and Other Factors Associated with Delayed Sputum Conversion in Patients with Pulmonary Tuberculosis. Infect Drug Resist 2022; 15:5455-5462. [PMID: 36131811 PMCID: PMC9484577 DOI: 10.2147/idr.s380166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with delayed intensive phase sputum conversion have a higher risk of multidrug resistant-tuberculosis (MDR-TB) and poorer treatment outcomes. Both, host (immune response and comorbidity) and pathogen factors play important roles in determining sputum conversion after treatment initiation. Impaired host immune response, especially the cellular components, as defined by the increased pre-treatment level of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and other additional factors, were associated with severe active TB. Purpose To evaluate whether impaired immune responses (high pre-treatment level of NLR and MLR) and other factors associate with delayed sputum conversion at the end of the intensive phase treatment. Patients and Methods This was a case–control study from 2016 to 2020, which retrospectively analyzed the pre-treatment level of NLR, MLR and other factors among patients with new cases of pulmonary tuberculosis (PTB). Results A total of 62 patients (31 cases and 31 control). The cut-off value of high pretreatment level of NLR and MLR was 5.065 and 0.585, respectively. Bivariate analysis showed that pretreatment NLR ≥5.065 (OR 8.23, CI 95% 2.48–27.32, p < 0.001), MLR ≥0.585 (OR 10.18, 95% CI 3.13–33.18, p < 0.001) and BMI <18.5 (OR 2.91, 95% CI 1.03–8.20, p = 0.041) were associated with an increased risk of delayed sputum conversion. Multivariate analysis, however, showed that pretreatment NLR ≥5.065 was not significantly associated with delayed sputum conversion (AOR 3.370, 95% CI 0.71–15.91, p value 0.125). A high pretreatment of MLR (AOR 30.802, 95% CI 3.22–287.55, p value 0.003) and lower BMI (AOR 10.942, 95% CI 1.121–98.563, p value 0.033) were significantly associated with an increased risk of delayed intensive phase sputum conversion. Conclusion High MLR pretreatment and a low BMI were significantly associated with an increased risk of delayed sputum conversion at the end of the PTB intensive phase treatment. High NLR pretreatment, smoking, diabetes, and HIV were not associated with sputum conversion.
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Affiliation(s)
- Ketut Suryana
- Division of Clinical Allergy-Immunology, Department of Internal Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.,Department of Internal Medicine, Merpati Clinic, Wangaya Hospital, Denpasar, Bali, Indonesia
| | - Ni Wayan Wina Dharmesti
- Department of Internal Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - I B Ngurah Rai
- Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia
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Combining metabolome and clinical indicators with machine learning provides some promising diagnostic markers to precisely detect smear-positive/negative pulmonary tuberculosis. BMC Infect Dis 2022; 22:707. [PMID: 36008772 PMCID: PMC9403968 DOI: 10.1186/s12879-022-07694-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) had been the leading lethal infectious disease worldwide for a long time (2014–2019) until the COVID-19 global pandemic, and it is still one of the top 10 death causes worldwide. One important reason why there are so many TB patients and death cases in the world is because of the difficulties in precise diagnosis of TB using common detection methods, especially for some smear-negative pulmonary tuberculosis (SNPT) cases. The rapid development of metabolome and machine learning offers a great opportunity for precision diagnosis of TB. However, the metabolite biomarkers for the precision diagnosis of smear-positive and smear-negative pulmonary tuberculosis (SPPT/SNPT) remain to be uncovered. In this study, we combined metabolomics and clinical indicators with machine learning to screen out newly diagnostic biomarkers for the precise identification of SPPT and SNPT patients. Methods Untargeted plasma metabolomic profiling was performed for 27 SPPT patients, 37 SNPT patients and controls. The orthogonal partial least squares-discriminant analysis (OPLS-DA) was then conducted to screen differential metabolites among the three groups. Metabolite enriched pathways, random forest (RF), support vector machines (SVM) and multilayer perceptron neural network (MLP) were performed using Metaboanalyst 5.0, “caret” R package, “e1071” R package and “Tensorflow” Python package, respectively. Results Metabolomic analysis revealed significant enrichment of fatty acid and amino acid metabolites in the plasma of SPPT and SNPT patients, where SPPT samples showed a more serious dysfunction in fatty acid and amino acid metabolisms. Further RF analysis revealed four optimized diagnostic biomarker combinations including ten features (two lipid/lipid-like molecules and seven organic acids/derivatives, and one clinical indicator) for the identification of SPPT, SNPT patients and controls with high accuracy (83–93%), which were further verified by SVM and MLP. Among them, MLP displayed the best classification performance on simultaneously precise identification of the three groups (94.74%), suggesting the advantage of MLP over RF/SVM to some extent. Conclusions Our findings reveal plasma metabolomic characteristics of SPPT and SNPT patients, provide some novel promising diagnostic markers for precision diagnosis of various types of TB, and show the potential of machine learning in screening out biomarkers from big data. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07694-8.
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Carranza C, Carreto-Binaghi LE, Guzmán-Beltrán S, Muñoz-Torrico M, Torres M, González Y, Juárez E. Sex-Dependent Differential Expression of Lipidic Mediators Associated with Inflammation Resolution in Patients with Pulmonary Tuberculosis. Biomolecules 2022; 12:biom12040490. [PMID: 35454079 PMCID: PMC9025322 DOI: 10.3390/biom12040490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
There is a sex bias in tuberculosis’s severity, prevalence, and pathogenesis, and the rates are higher in men. Immunological and physiological factors are fundamental contributors to the development of the disease, and sex-related factors could play an essential role in making women more resistant to severe forms of the disease. In this study, we evaluated sex-dependent differences in inflammatory markers. Serum samples were collected from 34 patients diagnosed with pulmonary TB (19 male and 15 female) and 27 healthy controls (18 male and 9 female). Cytokines IL2, IL4, IL6, IL8, IL10, IFNγ, TNFα, and GM-CSF, and eicosanoids PGE2, LTB4, RvD1, and Mar1 were measured using commercially available immunoassays. The MDA, a product of lipidic peroxidation, was measured by detecting thiobarbituric-acid-reactive substances (TBARS). Differential inflammation patterns between men and women were observed. Men had higher levels of IL6, IL8, and TNFα than women. PGE2 and LTB4 levels were higher in patients than healthy controls, but there were no differences for RvD1 and Mar1. Women had higher RvD1/PGE2 and RvD1/LTB4 ratios among patients. RvD1 plays a vital role in resolving the inflammatory process of TB in women. Men are the major contributors to the typical pro-inflammatory profile observed in the serum of tuberculosis patients.
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Affiliation(s)
- Claudia Carranza
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Laura Elena Carreto-Binaghi
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Silvia Guzmán-Beltrán
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
| | - Marcela Muñoz-Torrico
- Servicio Clínico de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico;
| | - Martha Torres
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Yolanda González
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
| | - Esmeralda Juárez
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
- Correspondence:
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11
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Ibrahim MN, Nik Husain NR, Daud A, Chinnayah T. Epidemiology and Risk Factors of Delayed Sputum Smear Conversion in Malaysian Aborigines with Smear-Positive Pulmonary Tuberculosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042365. [PMID: 35206552 PMCID: PMC8872111 DOI: 10.3390/ijerph19042365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
Background: Tuberculosis (TB) remains a serious public health challenge despite enormous eradication efforts. Indigenous groups worldwide have a higher TB incidence and associated delayed sputum–smear conversion. The aim of this case–control study was to determine the epidemiology and factors associated with delayed sputum–smear conversion among Malaysian aborigines. Methods: We used secondary data from 2016 to 2020 in the MyTB surveillance system. Malaysian aborigines with smear-positive pulmonary TB were enrolled and followed until the end of the intensive phase. Descriptive statistics and multiple logistic regression were used for data analysis. Results: Of 725 Malaysian aborigines with pulmonary TB, 572 (78.9%) were smear-positive and 487 (78.9%) fulfilled the study criteria. The mean (SD) age of smear-positive pulmonary TB was 39.20 (16.33) years. Majority of participants were male (63%), Senoi tribe (54.9%), living in rural areas (88.1%), formally educated (60.4%) and living below the poverty line (97.1%). Overall, 93 (19.1%) of 487 patients showed delayed sputum-smear conversion and significantly associated factors, such as smoking (AdjOR: 3.25; 95% CI: 1.88, 5.59), diabetes mellitus (AdjOR: 12.84; 95% CI: 6.33, 26.06), and HIV infection (AdjOR: 9.76; 95% CI: 3.01, 31.65). Conclusions: Stakeholders should adopt targeted approaches to tackle the problem of aboriginal groups with pulmonary TB and these associated risk factors to realise the End TB target.
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Affiliation(s)
- Muhammad Naim Ibrahim
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia; (M.N.I.); (A.D.)
| | - Nik Rosmawati Nik Husain
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia; (M.N.I.); (A.D.)
- Correspondence: ; Tel.: +60-9767-6621
| | - Aziah Daud
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia; (M.N.I.); (A.D.)
| | - Thilaka Chinnayah
- TB and Leprosy Control Sector, Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia;
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12
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Tamburini B, Badami GD, Azgomi MS, Dieli F, La Manna MP, Caccamo N. Role of hematopoietic cells in Mycobacterium tuberculosis infection. Tuberculosis (Edinb) 2021; 130:102109. [PMID: 34315045 DOI: 10.1016/j.tube.2021.102109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Tuberculosis remains one of the most significant causes of mortality worldwide and the current situation shows a re-emergence of TB due to the emergence of new antibiotic-resistant strains and the widespread of disease caused by immunodeficiencies. For these reasons, a big effort is made to improve the therapeutic strategies against Mycobacterium tuberculosis and to perform new therapeutic and diagnostic strategies. This review analyzes the various hematopoietic populations, their role and the different changes they undergo during Mycobacterium tuberculosis infection or disease. We have examined the population of lymphocytes, monocytes, neutrophils, eosinophils and platelets, in orderto understand how each of them is modulated during the course of infection/disease. In this way it will be possible to highlight the correlations between these cell populations and the different stages of tubercular infection. In fact, Mycobacterium tuberculosis is able to influence both proliferation and differentiation of hematopoietic stem cells. Several studies have highlighted that Mycobacterium tuberculosis can also infect progenitor cells in the bone marrow during active disease driving towards an increase of myeloid differentiation. This review focuses how the different stages of tubercular infection could impact on the different hematopoietic populations, with the aim to correlate the changes of different populations as biomarkers useful to discriminate infection from disease and to evaluate the effectiveness of new therapies.
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Affiliation(s)
- Bartolo Tamburini
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostic (Bi.N.D.); University of Palermo, Palermo 90127, Italy
| | - Giusto Davide Badami
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostic (Bi.N.D.); University of Palermo, Palermo 90127, Italy
| | - Mojtaba Shekarkar Azgomi
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostic (Bi.N.D.); University of Palermo, Palermo 90127, Italy
| | - Francesco Dieli
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostic (Bi.N.D.); University of Palermo, Palermo 90127, Italy
| | - Marco Pio La Manna
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostic (Bi.N.D.); University of Palermo, Palermo 90127, Italy
| | - Nadia Caccamo
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostic (Bi.N.D.); University of Palermo, Palermo 90127, Italy.
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13
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Sadamatsu H, Takahashi K, Tashiro H, Kusaba K, Haraguchi T, Kurihara Y, Komiya N, Nakashima C, Nakamura T, Kimura S, Sueoka-Aragane N. A Low Body Mass Index Is Associated with Unsuccessful Treatment in Patients with Mycobacterium avium Complex Pulmonary Disease. J Clin Med 2021; 10:jcm10081576. [PMID: 33918066 PMCID: PMC8070363 DOI: 10.3390/jcm10081576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background: A low body mass index (BMI) has been reported to be a poor prognostic factor for Mycobacterium avium complex pulmonary disease (MAC-PD). The purpose of this study was to clarify the clinical features of MAC-PD in cases with a low BMI. Methods: This retrospective study analyzed the data of patients diagnosed with MAC-PD at Saga University Hospital between 2008 and 2019. The analyzed patient characteristics included age, gender, BMI, symptoms, laboratory data, chest computed tomography findings, and the treatment courses. We also investigated the factors associated with successful treatment. Results: In total, 144 patients were included in this study. The low-BMI group (BMI < 18.5 kg/m2) had a higher incidence of sputum, Mycobacterium intracellurare infection, and cavitary lesions, in addition to lower blood lymphocyte counts, higher neutrophil–lymphocyte ratios, and a lower prognostic nutritional index (PNI) when compared to the preserved-BMI group (BMI ≥ 18.5 kg/m2). Sixty-six of the 144 patients (45.8%) received treatment. Hemosputum, acid-fast bacillus sputum smear positivity, low lymphocyte counts, a low PNI, and unsuccessful treatment (48.5% vs. 24.2%, p < 0.05) were found to be associated with a low BMI. Conclusions: A low BMI is associated with cavitary lesions, malnutrition, and unsuccessful treatment in MAC-PD.
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Affiliation(s)
- Hironori Sadamatsu
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
| | - Koichiro Takahashi
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
- Correspondence: ; Tel.: +81-952-34-2372; Fax: +81-952-34-2017
| | - Hiroki Tashiro
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
| | - Koji Kusaba
- Department of Laboratory Medicine, Saga University Hospital, Saga 849-8501, Japan;
| | - Tetsuro Haraguchi
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
| | - Yuki Kurihara
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
| | - Natsuko Komiya
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
| | - Chiho Nakashima
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
| | - Tomomi Nakamura
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
| | - Shinya Kimura
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
| | - Naoko Sueoka-Aragane
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.S.); (H.T.); (T.H.); (Y.K.); (N.K.); (C.N.); (T.N.); (S.K.); (N.S.-A.)
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14
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Zhang H, Qian X, Liu ZH, Gong Y. The value of bronchial and cavity contraction rates in differentiating benign and malignant pulmonary cavities. BMC Pulm Med 2020; 20:208. [PMID: 32762669 PMCID: PMC7409678 DOI: 10.1186/s12890-020-01238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aimed to assess the value of bronchial and cavity contraction percentages in differentiating benign and malignant pulmonary cavities. METHODS Forty-two patients with pulmonary cavities were scanned by dual-phase computed tomography (CT). Then, the cavity and bronchial contraction percentages were respectively measured, the differences between the benign and malignant cavities were compared, and the best diagnostic critical point for differentiating benign and malignant cavities was obtained through the receiver operator characteristic (ROC) curve of the diagnostic test. RESULTS The contraction percentage of the bronchial end with benign cavities was significantly higher than that of the bronchial end with malignant cavities (P < 0.001). The contraction percentage was significantly higher in the benign group than in the malignant group (P < 0.001). The ROC analysis revealed that the sensitivity and specificity of the bronchial contraction percentage was 90.50 and 86.40%, respectively, while the sensitivity and specificity of the cavity contraction percentage was 90.50 and 90.90%, respectively. CONCLUSION The dual-phase CT scanning of the bronchial and cavity contraction percentage can distinguish between benign and malignant cavities.
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Affiliation(s)
- Hua Zhang
- Department of Radiology, the Third Affiliated Hospital of Nanchang University (also known as the First Hospital of Nanchang), No.128 Xiangshan north road, Donghu district, Nanchang, 330008, China.
| | - Xia Qian
- Department of Radiology, the Third Affiliated Hospital of Nanchang University (also known as the First Hospital of Nanchang), No.128 Xiangshan north road, Donghu district, Nanchang, 330008, China
| | - Zheng-Hua Liu
- Department of Radiology, the Third Affiliated Hospital of Nanchang University (also known as the First Hospital of Nanchang), No.128 Xiangshan north road, Donghu district, Nanchang, 330008, China
| | - Yi Gong
- Department of Radiology, the Third Affiliated Hospital of Nanchang University (also known as the First Hospital of Nanchang), No.128 Xiangshan north road, Donghu district, Nanchang, 330008, China
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15
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Hachisu Y, Murata K, Takei K, Tsuchiya T, Tsurumaki H, Koga Y, Horie T, Takise A, Hisada T. Prognostic nutritional index as a predictor of mortality in nontuberculous mycobacterial lung disease. J Thorac Dis 2020; 12:3101-3109. [PMID: 32642232 PMCID: PMC7330762 DOI: 10.21037/jtd-20-803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Although the association between nontuberculous mycobacterial lung disease (NTM-LD) and malnutrition is known, there are a few reports on the association between the nutritional score and death in patients with NTM-LD. This study investigated the association between the nutrition data at the time of NTM-LD diagnosis and death. Methods A retrospective study was conducted for patients with NTM-LD who visited the Maebashi Red Cross Hospital from January 2014 to December 2018. The patients were divided into the survival and death groups and analyzed statistically. Results The diagnostic criteria for NTM-LD were met by 150 patients. The median age was 70 years (range, 20–94 years). There were 51 (34.0%) men and 99 (66.0%) women. In the death group, the body mass index was significantly low, and there were significantly more patients with asthma. Further, computed tomography at the first visit revealed significantly fewer cases of the nodular bronchiectasis type. In the hematologic examination at the time of NTM-LD diagnosis, the white blood cell, neutrophil, and platelet counts and C-reactive protein and serum calcium levels were significantly higher in the death group, while the serum albumin level was significantly lower. In the death group, the prognostic nutritional index (PNI), calculated from the hematologic findings, was significantly lower, while the Glasgow Prognostic Score (GPS) was significantly higher. A logistic regression analysis was performed on items with significant differences, and the PNI and platelet count were independent factors predicting death. Conclusions PNI might be effective as a prognostic factor for NTM-LD.
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Affiliation(s)
- Yoshimasa Hachisu
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Keisuke Murata
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Kousuke Takei
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Takuma Tsuchiya
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Hiroaki Tsurumaki
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasuhiko Koga
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takeo Horie
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Atsushi Takise
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Takeshi Hisada
- Gunma University Graduate School of Health Sciences, Maebashi, Japan
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16
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Hortle E, Oehlers SH. Host-directed therapies targeting the tuberculosis granuloma stroma. Pathog Dis 2020; 78:5800987. [DOI: 10.1093/femspd/ftaa015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT
Mycobacteria have co-evolved with their hosts resulting in pathogens adept at intracellular survival. Pathogenic mycobacteria actively manipulate infected macrophages to drive granuloma formation while subverting host cell processes to create a permissive niche. Granuloma residency confers phenotypic antimicrobial resistance by physically excluding or neutralising antibiotics. Host-directed therapies (HDTs) combat infection by restoring protective immunity and reducing immunopathology independent of pathogen antimicrobial resistance status. This review covers innovative research that has discovered ‘secondary’ symptoms of infection in the granuloma stroma are actually primary drivers of infection and that relieving these stromal pathologies with HDTs benefits the host. Advances in our understanding of the relationship between tuberculosis and the host vasculature, haemostatic system and extracellular matrix reorganisation are discussed. Preclinical and clinical use of HDTs against these stromal targets are summarised.
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Affiliation(s)
- Elinor Hortle
- Tuberculosis Research Program at the Centenary Institute, The University of Sydney, Camperdown, NSW 2050, Australia
- The University of Sydney, Faculty of Medicine and Health & Marie Bashir Institute, Camperdown, NSW 2050, Australia
| | - Stefan H Oehlers
- Tuberculosis Research Program at the Centenary Institute, The University of Sydney, Camperdown, NSW 2050, Australia
- The University of Sydney, Faculty of Medicine and Health & Marie Bashir Institute, Camperdown, NSW 2050, Australia
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17
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Merriman RC, Dissanayake O, Alnjar S, Burns F, Miller RF. Incidence and significance of elevated platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios among hospitalised HIV-positive adult patients. Int J STD AIDS 2019; 30:1329-1332. [PMID: 31726931 DOI: 10.1177/0956462419868881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is increasing interest in the peripheral blood platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) as markers of systemic inflammation. We audited records of unselected hospitalised HIV-positive adults to identify the frequency of elevated PLR and NLR, potential associations with specific diagnoses, and outcome. Of 259 patients audited, their median age was 47 years (interquartile range = 41–54); 188 (73%) were men. An elevated PLR occurred in 87 patients (33.6%); 67 (25.9%) had an elevated NLR; 200 (77%) had an elevated C-reactive protein (CRP). Elevated PLR and NLR was associated with a variety of infectious, inflammatory, and malignant conditions similar to conditions described in the general non-HIV-infected adult population. Additionally, elevated PLR and NLR occurred both in patients in receipt of antiretroviral therapy (with undetectable viral loads), as well as in those with newly-diagnosed and poorly-controlled infection. Fourteen patients with infectious and inflammatory conditions had an elevated PLR and normal CRP, with/without elevated NLR. There was no association between elevated PLR or NLR and ICU admission, p = 0.1001 and p = 0.605, respectively. Elevated NLR, but not PLR was associated with death, p = 0.0405 and p = 1.000, respectively: two-tailed Fisher’s exact test. The single site nature of the audit and relatively small number of patients limits these observations.
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Affiliation(s)
| | | | - Sara Alnjar
- HIV Services, Royal Free London NHS Foundation Trust, London, UK
| | - Fiona Burns
- HIV Services, Royal Free London NHS Foundation Trust, London, UK.,Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, UK
| | - Robert F Miller
- HIV Services, Royal Free London NHS Foundation Trust, London, UK.,Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, UK.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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