C-Reactive Protein Testing for Active Tuberculosis among Inpatients without HIV in Uganda: a Diagnostic Accuracy Study
Loading...
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Clinical Microbiology
Abstract
The objective of this prospective cross-sectional study, conducted at a
national referral hospital in Kampala, Uganda, was to determine diagnostic performance
of serum C-reactive protein (CRP) as a triage test for tuberculosis (TB) among
HIV-seronegative inpatients. We calculated the sensitivity, specificity, positive and
negative likelihood ratios, and positive and negative predictive values to determine
the diagnostic performance of a CRP enzyme-linked immunosorbent assay (ELISA)
(Eurolyser) in comparison to that of a reference standard of Mycobacterium tuberculosis
culture on two sputum samples. We constructed receiver operating curves and
reported performance in reference to the manufacturer’s cutoff and also to a threshold
chosen to achieve sensitivity of 90%, in accordance with the WHO’s targetproduct
profile for a triage test. Among 119 HIV-seronegative inpatients, 46 (39%)
had culture-positive pulmonary TB. In reference to M. tuberculosis culture, CRP had a
sensitivity of 78% (95% confidence interval [CI], 64 to 89%) and a specificity of 52%
(95% CI, 40 to 64%) at the manufacturer’s threshold of 10 mg/liter. At a threshold of
1.5 mg/liter, the sensitivity was 91% (95% CI, 79 to 98%) but the specificity was only
21% (95% CI, 12 to 32%). Performance did not differ when stratified by illness severity
at either threshold. In conclusion, among HIV-seronegative inpatients, CRP testing
performed substantially below targets for a TB triage test. Additional studies among
HIV-seronegative individuals in clinics and community settings are needed to assess
the utility of CRP for TB screening.
Description
Keywords
CRP, Africa, Diagnosis
Citation
Meyer AJ, Ochom E, Turimumahoro P, Byanyima P, Sanyu I, Lalitha R, Kaswabuli S, Andama A, Walter ND, Katamba A, Cattamanchi A, Worodria W, Huang L, Yoon C, Davis JL. 2021. C-reactive protein testing for active tuberculosis among inpatients without HIV in Uganda: a diagnostic accuracy study. J Clin Microbiol 59:e02162-20. https://doi.org/10 .1128/JCM.02162-20.