Diagnostic accuracy of C-reactive protein for active pulmonary tuberculosis: a meta-analysis
OBJECTIVE: To determine whether C-reactive protein (CRP) possesses the necessary test characteristics to screen individuals for active PTB.
DESIGN: We performed a systematic review and meta-analysis of studies evaluating the diagnostic accuracy of CRP (10 mg/l cut-off point) for culture-positive PTB. Pooled diagnostic accuracy estimates were generated using random-effects meta-analysis for out-patients and in-patients, and for pre-specified subgroups based on HIV status and test indication.
RESULTS: We identified nine unique studies enrolling 1793 adults from out-patient (five studies, 1121 patients) and in-patient settings (five studies, 672 patients), 72% of whom had confirmed HIV infection. Among out-patients, CRP had high sensitivity (93%, 95%CI 88–98) and moderate specificity (60%, 95%CI 40–75) for active PTB. Specificity was lowest among in-patients (21%, 95%CI 6–52) and highest among out-patients undergoing TB screening (range 58–81%). There was no difference in summary estimates by HIV status.
CONCLUSION: CRP, which is available as a simple, inexpensive and point-of-care test, can be used to screen PLHIV presenting for routine HIV/AIDS (acquired immune-deficiency syndrome) care for active TB.
Document Type: Research Article
Affiliations: 1: Department of Medicine, Division of Pulmonary & Critical Care Medicine 2: Department of Medicine, Division of General Medicine 3: Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California 4: Department of Medicine, Department of Medicine, Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts, USA 5: Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
Publication date: September 1, 2017
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