ORIGINAL RESEARCH article
Front. Microbiol.
Sec. Infectious Agents and Disease
Volume 16 - 2025 | doi: 10.3389/fmicb.2025.1653031
This article is part of the Research TopicRapid and Efficient Analytical Technologies for Pathogen DetectionView all 8 articles
Value of urinary Lipoarabinomannan levels for tuberculosis diagnosis and monitoring of therapy
Provisionally accepted
- 1Ningbo Yinzhou No 2 Hospital, Ningbo, China
- 2Lyceum of the Philippines University – Batangas, Batangas, Philippines
- 3Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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The 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.A 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.Against 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 identifiedΔLAM as independent predictors in total cohort (HR=0.013, p=0.001) and double positive group (HR=0.020, p=0.002).Urinary 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.
Keywords: Tuberculosis, Lipoarabinomannan, treatment monitoring, Diagnostic accuracy, Predictive modeling. 1.Introduction
Received: 25 Jun 2025; Accepted: 05 Aug 2025.
Copyright: © 2025 Xiong, Shen, Dong, Wang, Zhu, Wei, Zhang and Che. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hongxia Wei, Lyceum of the Philippines University – Batangas, Batangas, Philippines
Dongliang Zhang, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
Yang Che, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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