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C-reactive protein-based screening of people with tuberculosis symptoms: a diagnostic accuracy study

Rationale: C-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV. However, its performance among people without HIV and in diverse settings is unknown. - - Objectives: In a multicountry study, we aimed to determine whether CRP meets the minimum accuracy targe...

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Hauptverfasser: Derendinger, Brigitta (VerfasserIn) , Mochizuki, Tessa K. (VerfasserIn) , Marcelo, Danaida (VerfasserIn) , Shankar, Deepa (VerfasserIn) , Mangeni, Wilson (VerfasserIn) , Nguyen, Hanh (VerfasserIn) , Yerlikaya, Seda (VerfasserIn) , Worodria, William (VerfasserIn) , Yu, Charles (VerfasserIn) , Nguyen, Nhung Viet (VerfasserIn) , Christopher, Devasahayam Jesudas (VerfasserIn) , Theron, Grant (VerfasserIn) , Phillips, Patrick P. J. (VerfasserIn) , Nahid, Payam (VerfasserIn) , Denkinger, Claudia M. (VerfasserIn) , Cattamanchi, Adithya (VerfasserIn) , Yoon, Christina (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 2025
In: American journal of respiratory and critical care medicine
Year: 2025, Jahrgang: 211, Heft: 3, Pages: 499-506
ISSN:1535-4970
DOI:10.1164/rccm.202405-1000OC
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1164/rccm.202405-1000OC
Verlag, lizenzpflichtig, Volltext: https://www.atsjournals.org/doi/10.1164/rccm.202405-1000OC
Volltext
Verfasserangaben:Brigitta Derendinger, Tessa K. Mochizuki, Danaida Marcelo, Deepa Shankar, Wilson Mangeni, Hanh Nguyen, Seda Yerikaya, William Worodria, Charles Yu, Nhung Viet Nguyen, Devasahayam Jesudas Christopher, Grant Theron, Patrick P. J. Phillips, Payam Nahid, Claudia M. Denkinger, Adithya Cattamanchi, Christina Yoon
Beschreibung
Zusammenfassung:Rationale: C-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV. However, its performance among people without HIV and in diverse settings is unknown. - - Objectives: In a multicountry study, we aimed to determine whether CRP meets the minimum accuracy targets (sensitivity ⩾ 90%, specificity ⩾ 70%) for an effective TB screening test. - - Methods: Consecutive outpatient adults with cough ⩾2 weeks from five TB endemic countries in Africa and Asia had baseline blood collected for point-of-care CRP testing and HIV and diabetes screening. Sputum samples were collected for Xpert MTB/RIF Ultra (Xpert) testing and culture. CRP sensitivity and specificity (5 mg/L cut-point) was determined in reference to sputum test results and compared by country, sex, and HIV and diabetes status. Variables affecting CRP performance were identified using a multivariate receiver operating curve regression model. - - Measurements and Main Results: Among 2,904 participants, of whom 613 (21%) had microbiologically confirmed TB, CRP sensitivity was 84% (95% confidence interval [CI], 81-87%) and specificity was 61% (95% CI, 59-63%). CRP accuracy varied geographically, with higher sensitivity in African countries (⩾91%) than Asian countries (64-82%). Sensitivity was higher among men than women (86% vs. 78%; difference, +8%; 95% CI, 1-15%) and specificity was lower among people with HIV than people without HIV (64% vs. 45%; difference, +19%; 95% CI, 13-25%). Receiver operating curve regression identified country and measures of TB disease severity as predictors of CRP performance. - - Conclusions: Overall, CRP did not achieve the minimum accuracy targets, and its performance varied by setting and in some subgroups, likely reflecting population differences in mycobacterial load.
Beschreibung:Gesehen am 20.08.2025
Beschreibung:Online Resource
ISSN:1535-4970
DOI:10.1164/rccm.202405-1000OC

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