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Free Content Diagnostic accuracy of C-reactive protein for active pulmonary tuberculosis: a meta-analysis

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SETTING: Systematic screening for active pulmonary tuberculosis (PTB) is recommended for high-risk populations, including people living with the human immunodeficiency virus (PLHIV); however, currently recommended TB screening tools are inadequate for most high-burden settings.

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.
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Keywords: HIV; TB screening; symptom screen; systematic TB screening; systematic review

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

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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