Novel versus Traditional Serum Biomarkers in Predicting the Response to Anti-tubercular Therapy in Pulmonary Tuberculosis Patients: A Prospective Study

Background: India ranks first in the global share of tuberculosis (TB). Active TB is also associated with elevated levels of B-Cell growth factors like B-cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL). We aimed to study the circulating levels of ferritin, high-sensitivity C-reactive protein (hsCRP), BAFF, and APRIL in sputum-positive and sputum-negative active pulmonary TB (PTB) patients. Materials and Methods: We enrolled 90 sputum positive and 90 sputum-negative newly diagnosed PTB patients. All the patients underwent estimation of serum ferritin, hsCRP, BAFF, and APRIL before initiation of f Anti-Tubercular therapy (ATT), after 1 month of ATT, and after 2 months of ATT. We compared the change in the cytokines mentioned above in PTB subjects at baseline, after 01 and 02 months of the intensive phase of standard anti-tubercular therapy. Results: There was a significant difference between the serum BAFF levels at all times between the sputum-positive and sputum-negative groups (P < 0.001). There was a considerable increase in the APRIL level 2 months after initiation of ATT in both the groups (sputum positive group P = 0.004) (sputum negative group P < 0.001). There was a significant decrease in serum ferritin level and hsCRP after 2 months of ATT compared to baseline (P < 0.001) in both sputum positive and negative groups. Conclusion: Serum ferritin, hsCRP, and APRIL levels can be used to assess the treatment response in both sputum-positive and sputum-negative cases. Serum BAFF levels >587 pg/ml at baseline implies high probability of sputum smear positivity in a patient with PTB.