Affiliations: Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical
Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan | Graduate Institute of Clinical Medical Sciences, Chang
Gung University College of Medicine, Kaohsiung, Taiwan | Chang Gurg Technology Institute, Gia-Yi, Taiwan | Division of Rheumatology, Chang Gung Memorial
Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine,
Kaohsiung, Taiwan | Division of Pulmonary and Critical Care Medicine,
Xiamen Chang Gung Hospital, Xiamen, China
Note: [] Corresponding author: Dr. Meng-Chih Lin, Division of Pulmonary
and Critical Care Medicine, Department of Medicine, Chang Gung Memorial
Hospital, Kaohsiung 123, Ta-Pei Rd, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan.
Tel.: +886 7 7317123 ext. 8300; Fax: +886 7 7322402; E-mail:
linmengchih@hotmail.com
Abstract: Background and objective: Little is known about the usefulness of
lymphocyte subsets as early predictors of anti-tuberculosis (TB) treatment
response in immuno-competent patients. Methods: Among a total of 64 patients with culture positive
pulmonary TB, 29 remained sputum smear/culture positive or had delayed
resolution on CXR (slow responders (SR)), and 35 had sputum culture conversion
to negative and rapid resolution on CXR (fast responders (FR)) after two months
of anti-tuberculosis treatment. Clinical parameters and lymphocyte subsets were
investigated. Results: A larger proportion of patients in the SR group had
cavities on CXR, bilateral lung involvement, positive acid-fast bacilli stains,
and complaint of cough at diagnosis than those in the FR group. Absolute counts
of CD3^{+} T cells (p = 0.016) and
CD8^{+} T cells (p=0.012) at diagnosis were both
significantly higher in the SR group. This trend was present throughout the
6-month treatment course. Absolute T cell counts (odds ratio (OR) 1.002, 95%
confidence interval (CI) 1.0–1.004), positive sputum acid fast bacilli
stain (OR 6.69, 95% CI 1.37–32.77) and bilateral lung involvemment on CXR
(OR 13.114, 95% CI 1.87–92.14) at diagnosis were independent predictors
for a slow response. Combining these three predictors, a prediction score (PS)
could be calculated to display an optimal discrimination for slow response
(area under the curve (AUC)=0.855, p < 0.001), whereas absolute T cell
counts yielded the highest discriminative value on an individual level (AUC=
0.676, p=0.015). Conclusions: A higher T cell count at diagnosis in patients with TB
may predict a slow response to two months of treatment. The calculation of a PS
further increased predictive accuracy and performance.
