Diagnostic and prognostic value of serum C-reactive protein for screening for HIV-associated tuberculosis
SD Lawn, AD Kerkhoff, M Vogt… - The International journal …, 2013 - ingentaconnect.com
The International journal of tuberculosis and lung disease, 2013•ingentaconnect.com
BACKGROUND: Rapid means of ruling in or ruling out tuberculosis (TB) would permit more
efficient management of patients starting antiretroviral treatment (ART). OBJECTIVE: To
assess the diagnostic and prognostic utility of C-reactive protein (CRP) among patients
being screened for TB before ART in a South African ART clinic. DESIGN: Patients were
microbiologically screened for TB regardless of symptoms; serum CRP was measured, and
mortality at 3 months was assessed. RESULTS: Among 496 patients (median CD4 count …
efficient management of patients starting antiretroviral treatment (ART). OBJECTIVE: To
assess the diagnostic and prognostic utility of C-reactive protein (CRP) among patients
being screened for TB before ART in a South African ART clinic. DESIGN: Patients were
microbiologically screened for TB regardless of symptoms; serum CRP was measured, and
mortality at 3 months was assessed. RESULTS: Among 496 patients (median CD4 count …
BACKGROUND
Rapid means of ruling in or ruling out tuberculosis (TB) would permit more efficient management of patients starting antiretroviral treatment (ART).
OBJECTIVE
To assess the diagnostic and prognostic utility of C-reactive protein (CRP) among patients being screened for TB before ART in a South African ART clinic.
DESIGN
Patients were microbiologically screened for TB regardless of symptoms; serum CRP was measured, and mortality at 3 months was assessed.
RESULTS
Among 496 patients (median CD4 count 171 cells/l), culture-positive TB was diagnosed in 81 (16.3%). CRP concentrations were much higher among TB cases (median 57.8 mg/l, IQR 20.0202.7) than in those without TB (6.4 mg/l, IQR 2.121.8, P 400 mg/l) were strongly predictive of TB (100% positive predictive value). However, these thresholds encompassed only 14.3% and 2.0%, respectively, of all patients screened and identified only 12.3% of TB cases. CRP concentrations ≥50 mg/l were associated with poor prognostic characteristics, higher mycobacterial load, disseminated disease and greater mortality risk.
CONCLUSION
CRP concentrations identified groups of patients with very high or very low TB risk, but only in an unacceptably small minority of patients screened. However, in those with confirmed TB, CRP concentrations had useful prognostic value.
ingentaconnect.com