Growth Differentiation Factor‐15 Could Predict Decreased Hemoglobin in Tuberculosis Treated With Linezolid‐Containing Regimen

BACKGROUND: Linezolid effectively treats rifampicin-resistant tuberculosis (RR-TB) but can cause significant hematological toxicities linked to mitochondrial dysfunction in hematopoietic stem cells. Growth differentiation factor-15 (GDF-15) has been identified as a potential biomarker of this dysfunction. This study aimed to determine whether baseline GDF-15 levels can predict myelosuppression in RR-TB patients treated with linezolid. METHODS: The study included patients with RR-TB from three referral hospitals who were treated with a linezolid-containing regimen for at least 4 weeks. Hematological parameters and GDF-15 levels were measured at baseline as well as at the 2nd and 4th-8th weeks of treatment. RESULTS: Ninety-seven subjects were included in this study. By the 2nd week of linezolid treatment, GDF-15 levels significantly increased from a baseline of 635.58 (407.31-1583.65) to 708.96 (378.09-2408.89)pg/ml (p = 0.003). By weeks 4-8, 65% of patients developed myelosuppression. A correlation was found between baseline GDF-15 levels and hemoglobin reduction at weeks 4-8 (r = 0.4, p < 0.001). Baseline GDF-15 levels > 950 pg/mL identified patients with more than a 25% reduction in hemoglobin (AUC 0.756, 95% CI 0.659-0.838). CONCLUSION: Baseline GDF-15 levels were correlated with hemoglobin changes during the 4th-8th weeks of linezolid treatment. These levels can predict myelosuppression, particularly hemoglobin changes, in patients with RR-TB undergoing long-term linezolid therapy.