Author:
Derendinger Brigitta,Mochizuki Tessa K.,Marcelo Danaida,Shankar Deepa,Mangeni Wilson,Nguyen Hanh,Yerikaya Seda,Worodria William,Yu Charles,Nguyen Nhung Viet,Christopher Devasahayam Jesudas,Theron Grant,Phillips Patrick P.J.,Nahid Payam,Denkinger Claudia M.,Cattamanchi Adithya,Yoon Christina
Abstract
ABSTRACTRationaleC-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV (PWH). However, its performance among people without HIV and in diverse settings is unknown.ObjectivesIn a multi-country study, we aimed to determine whether CRP meets the minimum accuracy targets (sensitivity ≥90%, specificity ≥70%) for an effective TB triage test.Methods/MeasurementsConsecutive 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 characteristic (ROC) regression model.ResultsAmong 2904 participants, of whom 613 (21%) had microbiologically-confirmed TB, CRP sensitivity was 84% (95% 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 (87% vs. 79%, difference +8%, 95% CI: 1-15%) and specificity was higher among people without HIV than PWH (64% vs. 45%, difference +19%, 95% CI: 13-25%). ROC regression identified country and measures of TB disease severity as predictors of CRP performance.ConclusionsOverall, CRP did not achieve the minimum accuracy targets and its performance varied by setting and in some sub-groups, likely reflecting population differences in mycobacterial load.
Publisher
Cold Spring Harbor Laboratory
Reference33 articles.
1. Global Tuberculosis Report 2023 [Internet]. [cited 2024 Feb 2]. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023
2. WHO consolidated guidelines on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection, 2021 update [Internet]. [cited 2022 Nov 21]. Available from: https://www.who.int/publications-detail-redirect/9789240029415
3. Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis
4. Automatic Tuberculosis Screening Using Chest Radiographs
5. Computer aided detection of tuberculosis on chest radiographs: An evaluation of the CAD4TB v6 system;Sci Rep,2020
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献