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



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.



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



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).



The proposed composite score of suPAR + TBscore II 7 can improve TB case finding and clinical monitoring.
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.
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F
Rudolf
Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
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AJ
Wagner
Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
F M
FM
Back
Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
V F
VF
Gomes
Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
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P
Aaby
Department of Infectious Diseases, Aarhus University Hospital, Aarhus.
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L
Østergaard
Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
J
J
Eugen-Olsen
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.
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Wejse
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006169:Guinea-Bissau / Q000453:epidemiology; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*
D000995:Antitubercular Agents; D015415:Biomarkers; D055293:Receptors, Urokinase Plasminogen Activator