The utility of point-of-care urinary lipoarabinomannan testing for the diagnosis of tuberculosis in critically ill patients: a prospective observational study

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Abstract Background: Tuberculosis is a major global public health concern. Patients with tuberculosis who require critical care have a high mortality and delay in initiating anti-tuberculous therapy is associated with increased mortality. Lipoarabinomannan (LAM) is a lipopolysaccharide found in the cell wall of mycobacterium tuberculosis. Urinary LAM may be used as a bedside diagnostic test for tuberculosis.Methods: The study was a single centre, prospective observational study that compared the utility of urinary LAM with conventional tuberculosis diagnostic modalities in patients with suspected tuberculosis who required intensive care admission. Urinary LAM testing was performed using the Alere Determine TB LAM Ag lateral flow assay test strips. A patient was classified as having confirmed tuberculosis if they met the following criteria: a clinical presentation compatible with tuberculosis, with a positive TB culture, or 1 positive GeneXpert, or a histological diagnosis of tuberculosis.Results: Fifty patients were included in the study, with 12 having confirmed tuberculosis. Urinary LAM had a sensitivity of 50.0% and a specificity of 84.2% for confirmed tuberculosis. This compared with a sensitivity of 72.7% and a specificity of 100% for GeneXpert. There was no association between HIV status and CD4 count and urinary LAM results.Conclusion: Urinary LAM allows for rapid bedside diagnosis of tuberculosis in critically ill patients. A positive urinary LAM should prompt consideration to initiate antituberculous treatment while the results of further diagnostic testing are awaited.

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