Value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy
BackgroundThe urinary lipoarabinomannan (LAM) assay has emerged as a promising tool for tuberculosis (TB) diagnosis and treatment monitoring. This study aimed to evaluate the diagnostic and monitoring performance of LAM compared to Acid-fast bacilli (AFB), Mycobacteria Growth Indicator Tube (MGIT),...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmicb.2025.1653031/full |
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| author | Yiqun Xiong Zhihong Shen Bo Dong Ying Wang Ying Zhu Hongxia Wei Dongliang Zhang Yang Che |
| author_facet | Yiqun Xiong Zhihong Shen Bo Dong Ying Wang Ying Zhu Hongxia Wei Dongliang Zhang Yang Che |
| author_sort | Yiqun Xiong |
| collection | DOAJ |
| description | BackgroundThe urinary lipoarabinomannan (LAM) assay has emerged as a promising tool for tuberculosis (TB) diagnosis and treatment monitoring. This study aimed to evaluate the diagnostic and monitoring performance of LAM compared to Acid-fast bacilli (AFB), Mycobacteria Growth Indicator Tube (MGIT), and GeneXpert, and to establish its clinical utility in a stratified TB population.MethodsA prospective cohort study included TB patients stratified by AFB/MGIT status into three groups. Diagnostic accuracy was tested against composite reference standard (CRS). Early monitoring performance was assessed via serial LAM measurements during 12-week treatment. ROC/KM/Cox analyses determined optimal thresholds and predictors of LAM conversion.ResultsAgainst CRS, LAM demonstrated a sensitivity of 58.75%, which was numerically higher than AFB smear (45.00%, p = 0.082) and comparable to MGIT culture (58.75%, p = 1.00), but numerically lower than GeneXpert (61.25%, p = 0.205). In the early monitoring phase, LAM showed sustained positivity in 11.54–51.72% at week 12, compared to <15% for other methods. The diagnostic-monitoring quadrant analysis revealed LAM’s optimal positioning for monitoring (mean conversion time 4.63–11.49 weeks), compared to 0–8.25 weeks for other methods. A combined model incorporating baseline PreLAM and week 4 change (ΔLAM) showed the highest predictive value for 12 weeks conversion (AUC = 0.871–0.943). Multivariate cox analysis identified ΔLAM as independent predictors in total cohort (HR = 0.013, p = 0.001) and double positive group (HR = 0.020, p = 0.002).ConclusionUrinary LAM serves as a dual-role biomarker, providing moderate diagnostic sensitivity and dynamic monitoring signals reflecting early bacillary response to therapy. The PreLAM+ΔLAM model enables early treatment response assessment for personalized therapy. |
| format | Article |
| id | doaj-art-059ed42cd28b41939c61371aca5ae431 |
| institution | Kabale University |
| issn | 1664-302X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Microbiology |
| spelling | doaj-art-059ed42cd28b41939c61371aca5ae4312025-08-20T05:32:58ZengFrontiers Media S.A.Frontiers in Microbiology1664-302X2025-08-011610.3389/fmicb.2025.16530311653031Value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapyYiqun Xiong0Zhihong Shen1Bo Dong2Ying Wang3Ying Zhu4Hongxia Wei5Dongliang Zhang6Yang Che7Department of Infection, Ningbo Yinzhou No.2 Hospital, Ningbo, ChinaDepartment of Infection, Ningbo Yinzhou No.2 Hospital, Ningbo, ChinaDepartment of Infection, Ningbo Yinzhou No.2 Hospital, Ningbo, ChinaDepartment of Infection, Ningbo Yinzhou No.2 Hospital, Ningbo, ChinaDepartment of Infection, Ningbo Yinzhou No.2 Hospital, Ningbo, ChinaGraduate School, Lyceum of the Philippines University - Batangas, Batangas City, PhilippinesInstitute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, ChinaInstitute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, ChinaBackgroundThe urinary lipoarabinomannan (LAM) assay has emerged as a promising tool for tuberculosis (TB) diagnosis and treatment monitoring. This study aimed to evaluate the diagnostic and monitoring performance of LAM compared to Acid-fast bacilli (AFB), Mycobacteria Growth Indicator Tube (MGIT), and GeneXpert, and to establish its clinical utility in a stratified TB population.MethodsA prospective cohort study included TB patients stratified by AFB/MGIT status into three groups. Diagnostic accuracy was tested against composite reference standard (CRS). Early monitoring performance was assessed via serial LAM measurements during 12-week treatment. ROC/KM/Cox analyses determined optimal thresholds and predictors of LAM conversion.ResultsAgainst CRS, LAM demonstrated a sensitivity of 58.75%, which was numerically higher than AFB smear (45.00%, p = 0.082) and comparable to MGIT culture (58.75%, p = 1.00), but numerically lower than GeneXpert (61.25%, p = 0.205). In the early monitoring phase, LAM showed sustained positivity in 11.54–51.72% at week 12, compared to <15% for other methods. The diagnostic-monitoring quadrant analysis revealed LAM’s optimal positioning for monitoring (mean conversion time 4.63–11.49 weeks), compared to 0–8.25 weeks for other methods. A combined model incorporating baseline PreLAM and week 4 change (ΔLAM) showed the highest predictive value for 12 weeks conversion (AUC = 0.871–0.943). Multivariate cox analysis identified ΔLAM as independent predictors in total cohort (HR = 0.013, p = 0.001) and double positive group (HR = 0.020, p = 0.002).ConclusionUrinary LAM serves as a dual-role biomarker, providing moderate diagnostic sensitivity and dynamic monitoring signals reflecting early bacillary response to therapy. The PreLAM+ΔLAM model enables early treatment response assessment for personalized therapy.https://www.frontiersin.org/articles/10.3389/fmicb.2025.1653031/fulltuberculosislipoarabinomannantreatment monitoringdiagnostic accuracypredictive modeling |
| spellingShingle | Yiqun Xiong Zhihong Shen Bo Dong Ying Wang Ying Zhu Hongxia Wei Dongliang Zhang Yang Che Value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy Frontiers in Microbiology tuberculosis lipoarabinomannan treatment monitoring diagnostic accuracy predictive modeling |
| title | Value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy |
| title_full | Value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy |
| title_fullStr | Value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy |
| title_full_unstemmed | Value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy |
| title_short | Value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy |
| title_sort | value of urinary lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy |
| topic | tuberculosis lipoarabinomannan treatment monitoring diagnostic accuracy predictive modeling |
| url | https://www.frontiersin.org/articles/10.3389/fmicb.2025.1653031/full |
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