Hematochemical hallmarks as markers of pulmonary TB severity: A multicenter cross-sectional study.
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Di Gennaro Francesco, Guido Giacomo, Cotugno Sergio, Cavallin Francesco, Pisaturo Mariantonietta, Onorato Lorenzo, Zimmerhofer Federica, Pipitò Luca, De Iaco Giuseppina, Bruno Giuseppe, Fasano Massimo, Pontarelli Agostina, Botta Annarita, Iacovazzi Tiziana, Lattanzio Rossana, Di Bari Virginia, Panico Gianfranco, Libertone Raffaella, Monari Caterina, Musto Alessia, Niglio Mariangela, De Gregorio Federica, Brindicci Gaetano, Santoro Carmen Rita, Ronga Luigi, Papagni Roberta, De Vita Elda, Ieva Francesco Rosario Paolo, Alessio Loredana, Gualano Gina, Minniti Salvatore, Buccoliero Giovanni Battista, Lo Caputo Sergio, Carbonara Sergio, Cascio Antonio, Parrella Roberto, Palmieri Fabrizio, Coppola Nicola, Saracino Annalisa
Аннотация
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.