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Pedersen OS, Butova T, Kapustnyk V, Miasoiedov V, Kuzhko M, Hryshchuk L, Kornaha S, Borovok N, Raznatovska O, Fedorec A, Bogomolov A, Tkhorovskiy M, Akymenko O, Klymenko I, Kulykova O, Karpenko Z, Shapoval T, Chursina N, Kondratyuk N, Parkhomenko O, Sazonenko I, Ostrovskyy M, Makoida I, Markovtsiy L, Skryp V, Lubenko V, Hrankina N, Bondarenko L, Hlynenko V, Dahl VN, Butov D. Treatment outcomes and risk factors for an unsuccessful outcome among patients with highly drug-resistant tuberculosis in Ukraine. Clin Microbiol Infect 2024; 30:360-367. [PMID: 38065363 DOI: 10.1016/j.cmi.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES To describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome. METHODS Data from patients with multi-, pre-extensively, or extensively drug-resistant TB were collected prospectively from TB dispensaries in 15 out of 24 Ukrainian oblasts (regions) from 2020 to 2021. Treatment outcomes were evaluated using WHO definitions. Risk factors for an unsuccessful outcome were identified using a multivariable logistic regression model. RESULTS Among 1748 patients, the overall proportion of successful outcomes was 58% (95% confidence interval [95% CI] 56-60) (n = 1015/1748), ranging from 65% (95% CI: 62-69) (n = 531/814) for multidrug-resistant TB to 54% (95% CI: 49-58) (n = 301/563) for pre-extensively drug-resistant TB and 49% (95% CI: 44-55) (n = 183/371) for extensively drug-resistant TB. Results were similar across oblasts, with few exceptions. The strongest risk factors for an unsuccessful outcome were extensively drug-resistant TB (adjusted OR [aOR] 3.23; 95% CI: 1.88-5.53), total serum protein below 62 g/L in adults and below 57 g/L for children and adolescents (aOR 2.79; 95% CI: 1.93-4.04), psychiatric illness (aOR 2.79; 95% CI: 1.46-5.33), age at TB diagnosis >65 years (aOR 2.50; 95% CI: 1.42-4.42), and alcohol misuse (aOR 2.48; 95% CI: 1.89-3.26). DISCUSSION The overall proportion of successful outcomes among Ukrainians treated for highly drug-resistant TB was 58%, notably better compared with previous years, but still low for extensively drug-resistant TB. Risk factors for unsuccessful outcomes highlight that addressing socioeconomic factors in TB management is crucial. Efforts in maintaining TB dispensaries during and following the ongoing war are highly warranted.
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Affiliation(s)
- Ole Skouvig Pedersen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Tetiana Butova
- Outpatient Department, Merefa Central District Hospital, Merefa, Ukraine
| | | | | | - Mykhailo Kuzhko
- Department of Chemoresistant Tuberculosis, National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kiev, Ukraine
| | - Leonid Hryshchuk
- Department of Internal Medicine Propedeutics and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Svitlana Kornaha
- Department of Internal Medicine Propedeutics and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Natalia Borovok
- Medical Department No. 3, Regional Anti-tuberculosis Dispensary No 1 in Kharkiv, Kharkiv, Ukraine
| | - Olena Raznatovska
- Phthisiology and Pulmonology, Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
| | - Andrii Fedorec
- The Pulmonary Tuberculosis Department No. 2, Zaporizhzhia Regional Phthisiology and Pulmonology Clinical Treatment and Diagnostic Center, Zaporizhzhia, Ukraine
| | - Artemii Bogomolov
- Phthisiology, Clinical Immunology and Allergology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Mykhaylo Tkhorovskiy
- Phthisiology, Clinical Immunology and Allergology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Oleksandra Akymenko
- Medical Department No. 3, Regional Anti-tuberculosis Dispensary No 1 in Kharkiv, Kharkiv, Ukraine
| | | | - Olena Kulykova
- Outpatient Department, Regional Clinical Tuberculosis Dispensary, Kramatorsk, Ukraine
| | - Zhanna Karpenko
- Phthisiatry Center, Chernihiv Regional Hospital, Chernihiv, Ukraine
| | - Tetiana Shapoval
- Phthisiatry Center, Chernihiv Regional Hospital, Chernihiv, Ukraine
| | | | - Natalia Kondratyuk
- Bacteriological Laboratory, Volyn Regional Phthisiopulmonological Center, Lutsk, Ukraine
| | - Olha Parkhomenko
- Mykolaiv Regional Phthisio-pulmonological Medical Center, Mykolaiv, Ukraine
| | - Inna Sazonenko
- Phthisiology, Mykolaiv Regional Phthisiology and Pulmonology Medical Center, Mykolaiv, Ukraine
| | - Mykola Ostrovskyy
- Phthisiology and Pulmonology Rate of Occupational Diseases, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Iryna Makoida
- Phthisiology and Pulmonology Rate of Occupational Diseases, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | - Vasyl Skryp
- Center of Pulmonary Diseases, Uzhhorod, Ukraine
| | - Victoriya Lubenko
- Information and Analytical Department, Phthisiopulmonology Center, Kyiv, Ukraine
| | - Nataliia Hrankina
- Infectious Diseases and Phthisiology, Krivoy Rig Tuberculosis Dispensary, Dnipro, Ukraine
| | - Leonid Bondarenko
- Administration, Sumy Regional Clinical Anti-tuberculosis Dispensary, Sumy, Ukraine
| | - Valentyna Hlynenko
- Outpatient Department, Sumy Regional Clinical Anti-tuberculosis Dispensary, Sumy, Ukraine
| | - Victor Næstholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
| | - Dmytro Butov
- Infectious Diseases and Phthisiology, Kharkiv National Medical University, Kharkiv, Ukraine
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İşsever K, Dheir H. The Relationship Between Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Levels and Treatment Response in Patients With Glomerulonephritis: A Single-Center Experience. Cureus 2023; 15:e47473. [PMID: 38021795 PMCID: PMC10662779 DOI: 10.7759/cureus.47473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Aim Soluble urokinase-type plasminogen activator receptor (suPAR) is an important protein that is reported to increase in a broad range of inflammatory processes. We aimed to determine whether suPAR is a significant biomarker in glomerulonephritis for distinguishing patients with treatment response from patients without treatment response in our study. Materials and methods This was a prospective study in which 117 patients with biopsy-proven glomerulonephritis and 54 healthy individuals without a known chronic disease (control group) were enrolled. A total of 117 patients were divided into two groups: "treatment responsive" and "treatment nonresponsive." Blood samples were collected from the patients upon their outpatient clinic visits, and the demographical and lab parameters were compared between the groups. Results For the patient group consisting of 117 individuals, 56.4% were male, the mean age was 49.6 years, and the mean follow-up duration was 32.2 months. The most commonly diagnosed glomerular disease was focal segmental glomerulosclerosis (FSGS), followed by IgA nephropathy and membranoproliferative glomerulonephritis, respectively. While suPAR levels were significantly higher in the patient group (166.06 ± 127.66 vs. 119.67 ± 70.53 pg/ml, p = 0.001) (suPAR level ± standard deviation), no significant relationship was found between suPAR levels, treatment response status, and disease severity. Besides, there was no significant relationship between suPAR levels and proteinuria levels, BMI of the patients, and the type of immunosuppressive agent used in the treatment and BMI. Conclusion Our study showed that suPAR levels could distinguish a patient with glomerulonephritis from a healthy individual, whereas it has no value in predicting the disease progression and treatment responsiveness.
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Affiliation(s)
- Kubilay İşsever
- Internal Medicine, Giresun University Faculty of Medicine, Giresun, TUR
| | - Hamad Dheir
- Nephrology, Sakarya University Faculty of Medicine, Sakarya, TUR
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Mousavian Z, Folkesson E, Fröberg G, Foroogh F, Correia-Neves M, Bruchfeld J, Källenius G, Sundling C. A protein signature associated with active tuberculosis identified by plasma profiling and network-based analysis. iScience 2022; 25:105652. [PMID: 36561889 PMCID: PMC9763869 DOI: 10.1016/j.isci.2022.105652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/19/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Annually, approximately 10 million people are diagnosed with active tuberculosis (TB), and 1.4 million die of the disease. If left untreated, each person with active TB will infect 10-15 new individuals. The lack of non-sputum-based diagnostic tests leads to delayed diagnoses of active pulmonary TB cases, contributing to continued disease transmission. In this exploratory study, we aimed to identify biomarkers associated with active TB. We assessed the plasma levels of 92 proteins associated with inflammation in individuals with active TB (n = 20), latent TB (n = 14), or healthy controls (n = 10). Using co-expression network analysis, we identified one module of proteins with strong association with active TB. We removed proteins from the module that had low abundance or were associated with non-TB diseases in published transcriptomic datasets, resulting in a 12-protein plasma signature that was highly enriched in individuals with pulmonary and extrapulmonary TB and was further associated with disease severity.
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Affiliation(s)
- Zaynab Mousavian
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- School of Mathematics, Statistics and Computer Science, College of Science, University of Tehran, Tehran, Iran
| | - Elin Folkesson
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Gabrielle Fröberg
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Fariba Foroogh
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Margarida Correia-Neves
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga, Portugal
| | - Judith Bruchfeld
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Källenius
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christopher Sundling
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Corresponding author
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Enocsson H, Idoff C, Gustafsson A, Govender M, Hopkins F, Larsson M, Nilsdotter-Augustinsson Å, Sjöwall J. Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19. Front Med (Lausanne) 2021; 8:791716. [PMID: 34926532 PMCID: PMC8674575 DOI: 10.3389/fmed.2021.791716] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/12/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Efficient healthcare based on prognostic variables in hospitalised patients with COVID-19 could reduce the risk of complications and death. Recently, soluble urokinase Plasminogen Activator Receptor (suPAR) was shown to predict respiratory failure, kidney injury, and clinical outcome in patients with SARS-CoV-2 infection. The aim of this study was to investigate the value of suPAR as a prognostic tool, in comparison with other variables, regarding disease severity and length of hospital stay in patients with COVID-19. Patients and Methods: Individuals hospitalised with COVID-19 (40 males, 20 females; median age 57.5 years) with a median symptom duration of 10 days and matched, healthy controls (n = 30) were included. Admission levels of suPAR were measured in serum by enzyme-linked immunosorbent assay. Blood cell counts, C-reactive protein (CRP) levels, lactate dehydrogenase (LDH), plasma creatinine and estimated glomerular filtration rates were analysed and oxygen demand, level of care and length of hospitalisation recorded. Results: Patients had significantly higher suPAR levels compared to controls (P < 0.001). Levels were higher in severely/critically (median 6.6 ng/mL) compared with moderately ill patients (median 5.0 ng/mL; P = 0.002). In addition, suPAR levels correlated with length of hospitalisation (rho = 0.35; P = 0.006). Besides suPAR, LDH, CRP, neutrophil count, neutrophil-to-monocyte and neutrophil-to-lymphocyte ratio, body mass index and chronic renal failure were discriminators of COVID-19 severity and/or predictors of length of hospitalisation. Conclusion: Admission levels of suPAR were higher in patients who developed severe/critical COVID-19 and associated with length of hospital stay. In addition, we showed that suPAR functioned as an independent predictor of COVID-19 disease severity.
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Affiliation(s)
- Helena Enocsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Cornelia Idoff
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Annette Gustafsson
- Department of Infectious Diseases, The Vrinnevi Hospital, Norrköping, Sweden
| | - Melissa Govender
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Francis Hopkins
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Larsson
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johanna Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Infectious Diseases, The Vrinnevi Hospital, Norrköping, Sweden,*Correspondence: Johanna Sjöwall
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