Analytical performance of 17 commercially available point-of-care tests for CRP to support patient management at lower levels of the health system

Calarco, Serafina; Fernández-Carballo, B. Leticia; Keller, Thomas; Weber, Stephan; Jakobi, Meike; Marsall, Patrick; Schneiderhan‐Marra, Nicole; Dittrich, Sabine

doi:10.1101/2022.04.23.22273766

Cited by 1 publication

(2 citation statements)

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“…Rapid point-of-care C-reactive protein (CRP) tests could be particularly well suited for this indication, because they are inexpensive ($2 USD/test), generate results in 3 minutes, and can be performed with a fingerstick specimen. 15 Multiple studies have reported that CRP has superior diagnostic characteristics for the detection of TB at the time of HIV diagnosis, compared with the W4SS alone. [16][17][18][19] The WHO conditionally recommends the use of CRP with a cut-off of 5mg/L to screen for active TB in PLWH, with the caveat that more data are needed.…”

Section: Introductionmentioning

confidence: 99%

“…CRP is available as a simple, rapid, low-cost (<$US 2), point-of-care test, which is available from a variety of manufacturers. 15 Further study is necessary to define optimal CRP thresholds, which may potentially vary by number and type of symptoms. Moreover, CRP would not replace diagnostic testing for TB or other opportunistic infections and non-communicable diseases.…”

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confidence: 99%

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Potential Utility of C-reactive Protein for Tuberculosis Risk Stratification among Patients with Non-Meningitic Symptoms at HIV Diagnosis in Low- and Middle-Income Countries

Dupnik,

Rivera,

Dorvil

et al. 2023

Preprint

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Article SummaryWe assessed the association between C-reactive protein (CRP) andMycobacterium tuberculosis(TB) diagnosis in symptomatic patients at HIV diagnosis. We found that CRP concentrations can improve tuberculosis risk stratification, facilitating decision making about whether (specific) tuberculosis testing is indicated before antiretroviral therapy initiation.BackgroundThe World Health Organization recommends initiating same-day ART while tuberculosis testing is underway for patients with non-meningitic symptoms at HIV diagnosis, though safety data are limited. C-reactive protein (CRP) testing may improve tuberculosis risk stratification in this population.MethodsIn this baseline analysis of 498 adults (>18 years) with tuberculosis symptoms at HIV diagnosis who were enrolled in a trial of rapid ART initiation in Haiti, we describe test characteristics of varying CRP thresholds in the diagnosis of TB. We also assessed predictors of high CRP (≥3 mg/dL) using generalized linear models.ResultsEighty-seven (17.5%) patients were diagnosed with baseline TB. The median CRP was 33.0 mg/L (IQR: 5.1, 85.5) in those with TB, and 2.6 mg/L (IQR: 0.8, 11.7) in those without TB. As the CRP threshold increased from ≥1 mg/L to ≥10 mg/L, the positive predictive value for TB increased from 22.4% to 35.4%, and negative predictive value decreased from 96.9% to 92.3%. With CRP thresholds varying from <1 to <10 mg/L, a range from 25.5% to 64.9% of the cohort would have been eligible for same-day ART, and 0.8% to 5.0% would have untreated TB at ART initiation.ConclusionsCRP concentrations can be used to improve TB risk stratification, facilitating same-day decisions about ART initiation. Depending on the CRP threshold, one-quarter to two-thirds of patients could be eligible for same-day ART, with a reduction of 3-fold to 20-fold in the proportion with untreated TB, compared with a strategy of same-day ART while awaiting TB test results.

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