High serum levels of procalcitonin and soluble TREM-1 correlated with poor prognosis in pulmonary tuberculosis

Objectives: Comparisons of procalcitonin (PCT), C-reactive protein (CRP), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) would expand our knowledge of which biomarker is the best predictor for outcomes of patients with pulmonary tuberculosis (PTB). ;Methods: We prospectively enrolled 243 PTB patients, in whom PCT, CRP, and sTREM-1 measurement were performed to evaluate their prognostic value for 6-month mortality. ;Results: Serum PCT, CRP, and sTREM-1 levels on diagnosis of PTB were significantly higher in nonsurvivors (2.22 +/- 6.22 vs. 0.13 +/- 0.31 ng/mL, P = 0.043; 42.1 +/- 59.4 vs. 12.5 +/- 29.1 mg/L, P = 0.004; 332 +/- 362 vs. 128 +/- 98 pg/mL, P = 0.001, respectively) as compared with 6-month survivors. In multivariate Cox regression analysis, PCT >= 0.5 ng/mL (hazard ratio 4.13, 95% CI, 1.99-8.58) and sTREM-1 >= 129 pg/mL (hazard ratio 3.39, 95% CI, 1.52-7.58) remained independent mortality predictors. Serum PCT and sTREM-1 levels above the cutoffs were also associated with the presence of disseminated tuberculosis. ;Conclusions: Among PTB patients, higher PCT, CRP, and sTREM-1 levels are observed in nonsurvivors than in 6-month survivors. Serum levels of PCT and sTREM-1 over the cutoffs are independently associated with a poor outcome. In addition, higher PCT and sTREM-1 levels would raise the clinical suspicion of disseminated tuberculosis. (C) 2014 The Authors. Published by Elsevier Ltd on behalf of the The British Infection Association. All rights reserved