Genome-wide expression in human whole blood for diagnosis of latent tuberculosis infection: a multicohort research

Background Tuberculosis (TB) remains a significant global health challenge, necessitating reliable biomarkers for differentiation between latent tuberculosis infection (LTBI) and active tuberculosis (ATB). This study aimed to identify blood-based biomarkers differentiating LTBI from ATB through multicohort analysis of public datasets. Methods We systematically screened 18 datasets from the NIH Gene Expression Omnibus (GEO), ultimately including 11 cohorts comprising 2,758 patients across 8 countries/regions and 13 ethnicities. Cohorts were stratified into training (8 cohorts, n = 1,933) and validation sets (3 cohorts, n = 825) based on functional assignment. Results Through Upset analysis, LASSO (Least Absolute Shrinkage and Selection Operator), SVM-RFE (Support Vector Machine Recursive Feature Elimination), and MCL (Markov Cluster Algorithm) clustering of protein-protein interaction networks, we identified S100A12 and S100A8 as optimal biomarkers. A Naive Bayes (NB) model incorporating these two markers demonstrated robust diagnostic performance: training set AUC: median = 0.8572 (inter-quartile range 0.8002, 0.8708), validation AUC = 0.5719 (0.51645, 0.7078), and subgroup AUC = 0.8635 (0.8212, 0.8946). Conclusion Our multicohort analysis established an NB-based diagnostic model utilizing S100A12/S100A8, which maintains diagnostic accuracy across diverse geographic, ethnic, and clinical variables (including HIV co-infection), highlighting its potential for clinical translation in LTBI/ATB differentiation.