title: Evaluation of serum inflammatory biomarkers as predictors of treatment outcome in pulmonary tuberculosis.
abstract: To evaluate C-reactive protein (CRP), globulin and white blood cell (WBC) count as predictors of treatment outcome in pulmonary tuberculosis (PTB).
  
  
  
  An observational study of patients with active PTB was conducted at a tertiary centre. All patients had serum CRP, globulin and WBC measured at baseline and at 2 months following commencement of treatment. The outcome of interest was requirement for extension of treatment beyond 6 months.
  
  
  
  There were 226 patients included in the study. Serum globulin 45 g/l was the only baseline biomarker evaluated that independently predicted requirement for treatment extension (OR 3.42, 95%CI 1.597.32, P 0.001). An elevated globulin level that failed to normalise at 2 months was also associated with increased requirement for treatment extension (63.9% vs. 5.1%, P 0.001), and had a low negative likelihood ratio (0.07) for exclusion of requirement for treatment extension. On multivariable analysis, an elevated globulin that failed to normalise at 2 months was independently associated with requirement for treatment extension (OR 6.13, 95%CI 2.2316.80, P 0.001).
  
  
  
  Serum globulin independently predicts requirement for treatment extension in PTB and outperforms CRP and WBC as a predictive biomarker. Normalisation of globulin at 2 months following treatment commencement is associated with low risk of requirement for treatment extension.
authors.affiliation: Chest and Allergy Department, St Marys Hospital, Imperial College NHS Trust, London.
authors.forename: A
authors.initials: A
authors.lastname: Singanayagam
authors.affiliation: Chest and Allergy Department, St Marys Hospital, Imperial College NHS Trust, London.
authors.forename: K
authors.initials: K
authors.lastname: Manalan
authors.affiliation: Chest and Allergy Department, St Marys Hospital, Imperial College NHS Trust, London, Tuberculosis Immunology Group, Imperial College London, London.
authors.forename: D W
authors.initials: DW
authors.lastname: Connell
authors.affiliation: Tayside Respiratory Research Group, University of Dundee, Dundee, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Chalmers
authors.affiliation: Chest and Allergy Department, St Marys Hospital, Imperial College NHS Trust, London, Tuberculosis Immunology Group, Imperial College London, London.
authors.forename: S
authors.initials: S
authors.lastname: Sridhar
authors.affiliation: Chest and Allergy Department, St Marys Hospital, Imperial College NHS Trust, London.
authors.forename: A I
authors.initials: AI
authors.lastname: Ritchie
authors.affiliation: Chest and Allergy Department, St Marys Hospital, Imperial College NHS Trust, London, Tuberculosis Immunology Group, Imperial College London, London.
authors.forename: A
authors.initials: A
authors.lastname: Lalvani
authors.affiliation: Chest and Allergy Department, St Marys Hospital, Imperial College NHS Trust, London.
authors.forename: M
authors.initials: M
authors.lastname: Wickremasinghe
authors.affiliation: Chest and Allergy Department, St Marys Hospital, Imperial College NHS Trust, London.
authors.forename: O M
authors.initials: OM
authors.lastname: Kon
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005916:Globulins / Q000032:analysis; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000097:blood* / Q000188:drug therapy*
chemical_list: D015415:Biomarkers; D005916:Globulins; D002097:C-Reactive Protein