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. 2025 Mar 13:39:100517.
doi: 10.1016/j.jctube.2025.100517. eCollection 2025 May.

Hematochemical hallmarks as markers of pulmonary TB severity: A multicenter cross-sectional study

Affiliations

Hematochemical hallmarks as markers of pulmonary TB severity: A multicenter cross-sectional study

Francesco Di Gennaro et al. J Clin Tuberc Other Mycobact Dis. .

Abstract

Background: Identifying accessible and reliable biomarkers for tuberculosis (TB) severity is crucial for improving patient management. This study evaluates hematological findings as potential indicators of TB severity in a large multicenter Italian cohort.

Methods: This retrospective, multicenter, cross-sectional study analyzed hematological parameters (hemoglobin, white blood cells, inflammatory indices, hepatorenal function, albuminuria) in 577 TB patients from 10 Italian centers (2018-2023). Severe TB was defined by at least two criteria: TIMIKA score > 60, sputum conversion time > 21 days, or need for oxygen supplementation. Statistical analyses included receiver operating characteristic curve (AUC) evaluation, calibration curves, and clinical utility.

Results: Of the patients, 30.3 % were classified as severe, 60.2 % as non-severe, and 9.5 % as uncertain. AUC values for predicting severe TB ranged from 0.51 to 0.56 across hematological variables. Anemia and elevated CRP demonstrated sensitivities of 0.71 and 0.74, respectively. Models using continuous or categorical hematological variables achieved AUCs of 0.61 and 0.65, showing poor calibration and limited clinical utility in the 30-60 % threshold range.

Conclusions: Hematological markers, while rapid and cost-effective, demonstrated limited discriminative ability for TB severity. Further studies are required to develop reliable predictive models, integrating additional clinical and molecular data.

Keywords: Anemia; Disease progression; Hematochemical markers; Prognostic factors; TB control.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: No one reports was provided by University of Bari. Francesco Di Gennaro reports a relationship with University of Bari that includes: employment. Francesco DI Gennaro has patent licensed to Not applicable. Authors declare no conflict of interest If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Summary forest plot with the area under the receiver operating characteristic curve (AUC) with 95 % confidence interval (CI) for each hematological variable.
Fig. 2
Fig. 2
Calibration curves (A) and decision curves (B) for the risk prediction models. Higher net benefit suggests higher clinical utility. Model 1: model including the hematological variables as continuous variables. Model 2: model including the hematological variables as clinically relevant categories.

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