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Association of Xpert MTB/RIF Cycle Threshold Values with Tuberculosis Treatment Outcomes

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Abstract

Purpose

Considering the current recommendation of the World Health Organization to replace sputum smear microscopy with Xpert MTB/RIF as an initial diagnostic test for tuberculosis (TB), and that culture takes time to provide results, the cycle threshold (CT) of the Xpert test may be the only way to assess bacillary load. The objective of this study is to evaluate the association of bacillary load, measured by the Xpert CT, with the TB treatment outcomes.

Methods

In cohort study, Xpert CT values were evaluated in cured and non-cured (failure and death) patients. Multivariate analysis was performed to evaluate if CT is independently associated with TB treatment outcomes.

Results

During this study period, 155 patients (84 cured and 71 non-cured) met the inclusion and were included in the analysis. The mean CT value for Xpert MTB/RIF test was 20.7 ± 5.6 in cured patients and 17.1 ± 5.6 in non-cured patients (p < 0.0001). Previous TB was more frequent in non-cured (28.2%) than in cured patients (7.1%) (p < 0.0001). Non-cured patients were younger than cured ones (37.1 ± 13.3 vs 43.6 ± 16.2; p = 0.006). HIV was more frequent in non-cured (28.2%) than in cured patients (15.5%), although this difference was not statistically significant (p = 0.054). In multivariate analysis, CT values, age, previous TB, and HIV were independently associated with non-cure.

Conclusions

Lower Xpert MTB/RIF CT values were independently associated with worse treatment outcomes. The information from even a single test performed before starting treatment proved to be a relatively good predictor of TB treatment outcome.

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Data Availability

Data are available at Mendeley.

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Funding

Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre (FIPE-HCPA).

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Authors and Affiliations

  1. Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Matheus de Matto Pires, Giovana Rodrigues Pereira, Márcia Silva Barbosa & Denise Rossato Silva

  2. Laboratório Municipal de Alvorada, Alvorada, Brazil

    Giovana Rodrigues Pereira, Márcia Silva Barbosa, Natan José Dutra Dias & Carina Secchi

  3. Secretaria Municipal de Saúde, Alvorada, Brazil

    Jociane Saldanha Hoff

  4. Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Denise Rossato Silva

Authors
  1. Matheus de Matto Pires
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  2. Giovana Rodrigues Pereira
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  3. Márcia Silva Barbosa
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  4. Natan José Dutra Dias
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  5. Carina Secchi
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  6. Jociane Saldanha Hoff
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  7. Denise Rossato Silva
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Contributions

MMP designed the work, collected and analyzed data, and wrote the manuscript. GRP, MSB, NJDS, CS, and JSH designed the work, analyzed data, revised the manuscript. DRS designed the work, analyzed data, and wrote the manuscript.

Corresponding author

Correspondence to Denise Rossato Silva.

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Conflict of interest

The authors have no conflict of interest to declare.

Ethical Approval

The study was approved by the Research Ethics Committee of Hospital de Clínicas de Porto Alegre (number 160063), and all research was in accordance with regulations.

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All cases and controls signed informed consent form prior to inclusion in the study.

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All authors approved the submitted version.

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Pires, M.d., Pereira, G.R., Barbosa, M.S. et al. Association of Xpert MTB/RIF Cycle Threshold Values with Tuberculosis Treatment Outcomes. Lung 198, 985–989 (2020). https://doi.org/10.1007/s00408-020-00398-3

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  • DOI: https://doi.org/10.1007/s00408-020-00398-3

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