Ferritin, IL-6 and human-beta-defensin-1 as prognostic markers of the course severity and treatment effectiveness of pulmonary tuberculosis

Abstract

Current methods of investigation in TB patients, namely sputum microscopy, culture, and molecular genetic methods, although well-studied, have a number of disadvantages, such as low sensitivity, long time required to obtain results, or high cost. Because of this, the search for alternative diagnostic tools and methods for predicting the course and effectiveness of treatment in patients with tuberculosis becomes relevant. In this study, ferritin, interleukin-6 (IL-6), and human-beta-defensin-1 (HBD-1) were selected for comparison of prognostic performance. Objective — to investigate the dynamics of ferritin, IL-6, and human-beta-defensin-1 levels against the background of the intensive phase of pulmonary tuberculosis therapy and to identify the most effective marker for predicting the effectiveness of treatment. Materials and methods. 100 patients with pulmonary tuberculosis and 20 healthy individuals were included in the study. Examination of patients was carried out according to the current standards of providing medical care to tuberculosis patients. In addition, the patients' fasting blood ferritin, IL-6 and HBD-1 levels were determined at the beginning of treatment and after 60 days. Healthy individuals from the control group had a single determination of ferritin, IL-6 and HBD-1 blood levels on an empty stomach. Results and discussion. At the beginning of treatment, the ferritin level was significantly lower (95.95 ± 8.68) ng/ml in patients who later effectively completed the intensive phase of anti-tuberculosis treatment than in patients with ineffective intensive phase of treatment (152.27 ± 8.85) ng/ml. The same trend persisted after 60 days: in the effective intensive phase — (123.87 ± 13.39) ng/ml, in the ineffective one — (239.76 ± 12.91) ng/ml, p < 0.05. In effective intensive phase of antituberculosis treatment, the level of IL-6 was significantly lower. Thus, at the beginning of treatment, it was (82.59 ± 6.89) pg/ml in patients with an effective intensive phase of treatment and (146.42 ± 8.04) pg/ml in patients with ineffective intensive treatment phase. After 60 days, it was (48.88 ± 4.19) pg/ml in patients with an effective intensive phase of treatment and (142.89 ± 9.11) pg/ml in patients with ineffective intensive treatment phase, p < 0.05. The level of HBD-1 was higher when the intensive phase of antituberculosis therapy was ineffective, as when measured at the beginning of treatment (effective intensive phase — (18.71 ± 3.31) pg/ml, ineffective intensive phase — (32.79 ± 8.31) pg/ml), as well as when measured after 60 days (effective intensive phase — (19.93 ± 3.58) pg/ml, ineffective intensive phase — (42.92 ± 12.99) pg/ml, p < 0.05). Conclusions. Levels of ferritin, IL-6 and HBD-1 are significantly increased in tuberculosis patients compared to healthy individuals, which allows them to be considered as markers of tuberculosis inflammation. Higher concentrations of these markers, both at the beginning of treatment and after 60 doses, are predictors of failure of antituberculosis therapy. The strongest relationship between the studied markers and parameters of the severity of the tuberculosis process is observed in the study of HBD-1, which allows us to consider it as the most effective marker of the severity of the course among presented ones.