Identification of Factors Determining Patterns of Serum C-Reactive Protein Level Reduction in Response to Treatment Initiation in Patients with Drug-Susceptible Pulmonary Tuberculosis
Agnija Kivrane,
Viktorija Ulanova,
Solveiga Grinberga,
Eduards Sevostjanovs,
Anda Viksna,
Iveta Ozere,
Ineta Bogdanova,
Ilze Simanovica,
Inga Norvaisa,
Leonora Pahirko,
Dace Bandere,
Renate Ranka
Affiliations
Agnija Kivrane
Pharmacogenetic and Precision Medicine Laboratory, Pharmaceutical Education and Research Centre, Riga Stradins University, Konsula Street 21, LV1007 Riga, Latvia
Viktorija Ulanova
Pharmacogenetic and Precision Medicine Laboratory, Pharmaceutical Education and Research Centre, Riga Stradins University, Konsula Street 21, LV1007 Riga, Latvia
Solveiga Grinberga
Laboratory of Physical Organic Chemistry, Latvian Institute of Organic Synthesis, Aizkraukles Street 21, LV1006 Riga, Latvia
Eduards Sevostjanovs
Laboratory of Physical Organic Chemistry, Latvian Institute of Organic Synthesis, Aizkraukles Street 21, LV1006 Riga, Latvia
Anda Viksna
Department of Infectiology, Riga Stradins University, Dzirciema Street 16, LV1007 Riga, Latvia
Iveta Ozere
Department of Infectiology, Riga Stradins University, Dzirciema Street 16, LV1007 Riga, Latvia
Ineta Bogdanova
Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Stopini Region, LV2118 Upeslejas, Latvia
Ilze Simanovica
Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Stopini Region, LV2118 Upeslejas, Latvia
Inga Norvaisa
Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Stopini Region, LV2118 Upeslejas, Latvia
Leonora Pahirko
Faculty of Science and Technology, University of Latvia, Jelgavas Street 3, LV1004 Riga, Latvia
Dace Bandere
Department of Pharmaceutical Chemistry, Pharmaceutical Education and Research Centre, Riga Stradins University, Konsula Street 21, LV1007 Riga, Latvia
Renate Ranka
Pharmacogenetic and Precision Medicine Laboratory, Pharmaceutical Education and Research Centre, Riga Stradins University, Konsula Street 21, LV1007 Riga, Latvia
Background: Serum C-reactive protein (CRP) levels vary depending on radiological and bacteriological findings at the time of tuberculosis (TB) diagnosis. However, the utility of this biomarker in monitoring response to anti-TB treatment and identifying patients at risk of treatment failure is not well established. Objectives: This study evaluated the impact of patients’ baseline characteristics and anti-TB drug plasma exposure on the early reduction in serum CRP levels and its relationship with treatment response. Methods: We enrolled 42 patients with drug-susceptible pulmonary TB, who received a standard six-month regimen. The plasma concentrations of four anti-TB drugs were analysed using LC-MS/MS. Clinically relevant data, including serum CRP levels before and 10–12 days after treatment initiation (CRP10–12d), were obtained from electronic medical records and patient questionnaires. Results: In 10–12 days, the median serum CRP level decreased from 21.9 to 6.4 mg/L. Lower body mass index, positive sputum-smear microscopy results, and lung cavitations at diagnosis were related to higher biomarker levels at both time points; smoking had a more pronounced effect on serum CRP10–12d levels. Variability in anti-TB drug plasma exposure did not significantly affect the reduction in serum CRP levels. The serum CRP10–12d levels, or fold change from the baseline, did not predict the time to sputum culture conversion. Conclusions: Disease severity and patient characteristics may influence the pattern of early CRP reduction, while anti-TB drug plasma exposure had no significant effect at this stage. These early changes in serum CRP levels were not a predictor of response to anti-TB therapy.
