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Meta-Analysis
. 2017 Sep 1;21(9):1013-1019.
doi: 10.5588/ijtld.17.0078.

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

C Yoon  1 , L H Chaisson  1 , S M Patel  2 , I E Allen  3 , P K Drain  4 , D Wilson  5 , A Cattamanchi  1
Affiliations
Meta-Analysis

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

C Yoon et al. Int J Tuberc Lung Dis. .

Abstract

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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Figures

Figure 1
Figure 1. Flow diagram of studies
Abbreviations: CRP (C-reactive protein); TB (tuberculosis). Legend: An updated search performed on October 20, 2015 to identify additional studies published between February 1, 2014 and January 31, 2015 yielded no additional eligible studies
Figure 2
Figure 2. Outpatient pulmonary tuberculosis study quality using the Quality Assessment of Diagnostic Studies (QUADAS-2) tool
A. Summary study quality. B. Individual study quality. *C-reactive protein evaluated as a screening test for pulmonary tuberculosis among people living with HIV †C-reactive protein evaluated as a diagnostic test for pulmonary tuberculosis among people with smear-negative sputa
Figure 2
Figure 2. Outpatient pulmonary tuberculosis study quality using the Quality Assessment of Diagnostic Studies (QUADAS-2) tool
A. Summary study quality. B. Individual study quality. *C-reactive protein evaluated as a screening test for pulmonary tuberculosis among people living with HIV †C-reactive protein evaluated as a diagnostic test for pulmonary tuberculosis among people with smear-negative sputa
Figure 3
Figure 3. Diagnostic accuracy of CRP for pulmonary tuberculosis among outpatients
A. Forest plot. B. Hierarchical summary receiver operating characteristics (HSROC) plot. Abbreviations: CRP (C-reactive protein) *CRP evaluated as a screening test for tuberculosis †CRP evaluated as a diagnostic test for symptomatic patients undergoing tuberculosis evaluation Pooled sensitivity 93% (95% CI: 85–97); test for heterogeneity I2 = 39%, p=0.16 Pooled specificity 62% (95% CI: 42–79); test for heterogeneity I2 = 96%, p<0.0001
Figure 3
Figure 3. Diagnostic accuracy of CRP for pulmonary tuberculosis among outpatients
A. Forest plot. B. Hierarchical summary receiver operating characteristics (HSROC) plot. Abbreviations: CRP (C-reactive protein) *CRP evaluated as a screening test for tuberculosis †CRP evaluated as a diagnostic test for symptomatic patients undergoing tuberculosis evaluation Pooled sensitivity 93% (95% CI: 85–97); test for heterogeneity I2 = 39%, p=0.16 Pooled specificity 62% (95% CI: 42–79); test for heterogeneity I2 = 96%, p<0.0001
Figure 4
Figure 4. Diagnostic accuracy of CRP for pulmonary tuberculosis among ambulatory patients with confirmed HIV infection
A. Forest plot B. Hierarchical summary receiver operating characteristics (HSROC) plot. Abbreviations: CRP (C-reactive protein) *CRP evaluated as a screening test for tuberculosis †CRP evaluated as a diagnostic test for symptomatic patients undergoing tuberculosis evaluation Pooled sensitivity 93% (95% CI: 85–97); test for heterogeneity I2 = 40%, p=0.16 Pooled specificity 64% (95% CI: 42–81); test for heterogeneity I2 = 96%, p<0.0001
Figure 4
Figure 4. Diagnostic accuracy of CRP for pulmonary tuberculosis among ambulatory patients with confirmed HIV infection
A. Forest plot B. Hierarchical summary receiver operating characteristics (HSROC) plot. Abbreviations: CRP (C-reactive protein) *CRP evaluated as a screening test for tuberculosis †CRP evaluated as a diagnostic test for symptomatic patients undergoing tuberculosis evaluation Pooled sensitivity 93% (95% CI: 85–97); test for heterogeneity I2 = 40%, p=0.16 Pooled specificity 64% (95% CI: 42–81); test for heterogeneity I2 = 96%, p<0.0001
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References

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