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 Gung Technology Institute, Gia-Yi, Taiwan | Division of Rheumatology, Chang Gung Memorial
Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine,
Kaohsiung, Taiwan | 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, 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: Objective: To identify patients at high risk of relapse after
anti-tuberculosis (TB) therapy or with poor long-term outcomes. Methods: Fifty-one patients with pulmonary TB: 7 were classified as high association
with both cavitations on initial chest radiography and positive sputum
smear/cultures after two months of anti-TB treatment (HA group); 19 medium
association (MA, one risk alone); and 25 low association (LA, neither risk).
Serum interferon (IFN)-γ-inducible protein 10 (IP-10), interleukin-17
(IL-17), and C-reactive protein levels were investigated. Results: There was a trend towards higher serum IP-10 levels (p=0.042) for HA patients
throughout the 6-month treatment period. Month-2 IP-10 levels were higher in
the HA than in the MA/LA group (656.2 ± 234.4 vs. 307.6 ±
258.5 pg/ml, adjusted p =0.005). Receiver operating characteristic curves
showed that the risk of relapse was well-captured by month-2 IP-10 levels at a
cut-off value of 431 pg/ml (AUC=0.857, 95% CI 0.75–0.97, p =0.003).
Month-2 serum IL-17 levels were lower in non-survivors than survivors
(15.7 ± 2.9 pg/ml vs. 24.6 ± 8.2 pg/ml, p=0.001). Multivariate
analysis demonstrated that a month-2 serum IL-17 level of ⩽ 17 pg/ml (p
=0.026) was independently associated with all-cause mortality. Conclusions: Serum IP-10 and IL-17 levels after 2 months of anti-TB treatment
may be biomarkers for estimating risk of both cavitation and delayed sputum
conversion, and for predicting long-term mortality, respectively.
Keywords: Pulmonary tuberculosis, interferon-γ-inducible protein 10, interleukin-17, caviation, mortality
