Pre-Treatment Neutrophil Count as a Predictor of Antituberculosis Therapy Outcomes: A Multicenter Prospective Cohort Study

Abstract 

Methods: We prospectively assessed 936 patients (172 HIV-seropositive) with culture-confirmed pulmonary TB from different regions in Brazil between 2015 and 2019. Complete blood counts were measured at baseline. Treatment outcome was defined as either unfavorable (death, treatment failure, or TB recurrence) or favorable (cure or treatment completion). We performed multivariable logistic regression with propensity score adjustment to estimate the association between neutrophil count and treatment outcomes.

]Results: Of 691 TB patients followed for up to 24 months, 56 (8.1%) had an unfavorable treatment outcome. Multivariable regression found an association between higher neutrophil count ($10^3/mm^3$) at baseline and unfavorable outcome among HIV-seronegative patients (OR = 1.17; 95% CI = 1.06–1.30). Adjusted Cox regression also found that higher baseline neutrophil count was associated with unfavorable treatment outcomes overall and specifically among HIV-seronegative patients (HR = 1.16; 95% CI = 1.05–1.27).

Conclusion: Increased neutrophil count prior to anti-TB treatment initiation was associated with unfavorable treatment outcomes, particularly among HIV-seronegative patients.

Keywords: tuberculosis; neutrophils; treatment outcome; biomarker; neutrophil count.

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• Data de Publicação: 02/07/2021
• Autores: Anna Cristina C. Carvalho1,2† , Gustavo Amorim3† , Mayla G. M. Melo2,4† , Ana Karla A. Silveira2,4, Pedro H. L. Vargas 2,4, Adriana S. R. Moreira2 , Michael S. Rocha5,6, Alexandra B. Souza7 , Mar ́ıa B. Arriaga5,8,9, Mariana Arau ́ jo-Pereira5,8,9, Marina C. Figueiredo10, Betina Durovni 11, Jose ́ R. Lapa-e-Silva2 , Solange Cavalcante11, Valeria C. Rolla12, Timothy R. Sterling10† , Marcelo Cordeiro-Santos 7† , Bruno B. Andrade5,8,9,10,13,14† , Elisangela C. Silva2,4,15† , Afraˆ nio L. Kritski 2,4*† and the RePORT Brazil consortium