Screening performance of C-reactive protein for active pulmonary tuberculosis in HIV-positive patients: A systematic review with a meta-analysis

Abstract

BackgroundTuberculosis (TB) is the leading infectious cause of mortality worldwide. In the last years, resistant strains of the etiological agent, Mycobacterium tuberculosis, have emerged, thus demanding more triage tests to identify active pulmonary TB (PTB) patients and to evaluate their disease severity. Therefore, acute-phase reaction serum tests are required for monitoring TB patients, among WHO symptom screening recommendations. C-reactive protein (CRP) is a non-specific inflammatory biomarker that has been recently proposed for TB screening and can be quantitatively analyzed through cost-effective point-of-care assays. A previous meta-analysis found CRP to be highly sensitive and moderately specific for active PTB with confirmed HIV infection.MethodsWe performed a meta-analysis update of diagnostic tests, pooling sensitivities, and specificities in order to assess the accuracy of CRP as a potential test for the screening of HIV-associated PTB in outpatients. We searched MEDLINE, Web of Science, and SCOPUS for eligible articles before 19 October 2021.ResultsWe identified 13 eligible studies with HIV-positive patients with PTB. At a CRP threshold of 10 mg/L, CRP pooled sensitivity was 87% (76%–93%) and pooled specificity was 67% (49%–81%), with an area under the curve (AUC) of 0.858. Using a CRP threshold of 8 mg/L, pooled sensitivity was 82% (72%–89%) and pooled specificity was 82% (67%–92%), with an AUC of 0.879. We found that CRP has a high sensitivity in the screening of PTB in HIV-positive outpatients, consistent with findings reported previously.ConclusionsRegardless of pooled specificity, better results were found using the CRP threshold of 8 mg/L as a test screening of PTB, meeting the need of further approaching specific TB diagnostic methods and reducing resource consumption.

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus

“…The concentrations of acute-phase reactants such as CRP (>8 mg/L) [ 19 , 49 ] and total sialic acid (>2.22 mmol/L ≥68.65 mg/dL) were elevated in both groups, with a trend towards higher values in subjects with APTB (Table 2 ) [ 44 ]. However, no significant differences were found in either marker when both groups were compared.…”

Pathogenesis, Prophylaxis, and Treatment of Candida auris

“…There is mounting evidence that C. auris can colonize hospital surroundings over time and is more likely to spread in healthcare settings [ 48 , 49 ]. Since C. auris is frequently resistant to numerous antifungal medication classes, infection prevention in healthcare settings led by rapid identification is crucial [ 50 ]. Inadequate screening protocols may result in misdiagnosis or delayed diagnosis, increased rates of transmission and mortality, and severe cost implications [ 50 ].…”

“…It is important to identify Candida isolates from typically sterile body areas down to the species level so that early medication can be tailored to the patient’s expected sensitivity to the disease [ 14 ]. When conventional testing techniques are used in the microbiology lab, C. auris is frequently misidentified [ 26 , 50 ]. The diagnosis must be comprehensive and approach multiple directions, for example, other complementary tests, such as C reactive protein, which may be particularly important for tracking the course of the illness or the efficacy of treatment [ 50 ].…”

“…When conventional testing techniques are used in the microbiology lab, C. auris is frequently misidentified [ 26 , 50 ]. The diagnosis must be comprehensive and approach multiple directions, for example, other complementary tests, such as C reactive protein, which may be particularly important for tracking the course of the illness or the efficacy of treatment [ 50 ]. Due to their increased accessibility and lower cost as blood tests, the usefulness of the neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio as indicators of systemic inflammation has been examined in many studies conducted in recent years [ 40 ].…”

From simple to complex: Protein‐based biomarker discovery in tuberculosis

“…It is also a component of several of the more promising multiprotein biosignatures [12][13][14], in particular in HIV-infected individuals [15]. Similarly, interferon-gamma inducible protein 10 (IP-10), also called CXCL10, has been extensively evaluated as a biomarker for TB (Fig.…”