Evaluation of Tuberculosis Treatment Response With Serial C-Reactive Protein Measurements

Abstract

BackgroundNovel biomarkers are needed to assess response to antituberculosis therapy in smear-negative patients.MethodsTo evaluate the utility of C-reactive protein (CRP) in monitoring response to antituberculosis therapy, we conducted a post hoc analysis on a cohort of adults with symptoms of tuberculosis and negative sputum smears in a high–tuberculosis and HIV prevalence setting in KwaZulu-Natal, South Africa. Serial changes in CRP, weight, and hemoglobin were evaluated over 8 weeks.ResultsFour hundred twenty-one participants being evaluated for smear-negative tuberculosis were enrolled, and 33 were excluded. Two hundred ninety-five were treated for tuberculosis (137 confirmed, 158 possible), and 93 did not have tuberculosis. One hundred and eighty-three of 213 (86%) participants who agreed to HIV testing were HIV positive. At week 8, the on-treatment median CRP reduction in the tuberculosis group (interquartile range [IQR]) was 79.5% (25.4% to 91.7%), the median weight gain was 2.3% (−1.0% to 5.6%), and the median hemoglobin increase was 7.0% (0.8% to 18.9%); P < .0001 for baseline to week 8 comparison of absolute median values. Only CRP changed significantly at week 2 (median reduction [IQR], 75.1% [46.9% to 89.2%]) in the group with confirmed tuberculosis and in the possible tuberculosis group (median reduction [IQR], 49.0% [−0.4% to 80.9%]). Failure of CRP to reduce to ≤55% of the baseline value at week 2 predicted hospitalization or death in both tuberculosis groups, with 99% negative predictive value.ConclusionsChange in CRP may have utility in early evaluation of response to antituberculosis treatment and to identify those at increased risk of adverse outcomes.

Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation

“…Of these, 753 articles were excluded, resulting in 60 that met the selection criteria and 5603 enrolled participants (of whom 5261 were analyzed). 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ...…”

“…The durations of follow-up ranged from 1 to 60 months (median, 12 months). A total of 21 studies were from Western Europe, 25 , 27 , 41 , 54 , 61 , 62 , 65 , 72 , 81 , 82 , 84 11 from North America, 25 , 27 , 41 , 54 , 61 , 62 , 65 , 72 , 81 , 82 , 84 9 from East Asia, 29 , 38 , 39 , 44 , 51 , 52 , 60 , 66 , 68 5 from South America, 28 , 69 , 78 , 79 , 83 5 from Western Asia, 28 , 69 , 78 , 79 , 83 and 3 each from Africa, 35 , 50 , 76 the Pacific, 26 , 42 , 75 and Eastern Europe. 45 , 74 , 80 …”

“…Other populations were subjected to operations or therapies that adversely cause lean mass loss and/or fat mass gain, such as prostate, 27 , 42 esophageal, 39 head and neck squamous cell 44 cancers, and psychosis, 53 or where the disease course itself (ie, tuberculosis) causes lean mass loss and/or fat mass gain. 50 …”

A Rare Cause of Ascites-Disseminated TB with Peritonitis in a Middle-Aged Female

“…Reduction in CRP levels after ATT is well described before in several cohorts of tuberculous patients. In one study when CRP levels decrease ≤55% at 2 weeks, it predicted death or hospitalization, with a negative predictive value of 99% [12]. Failure to see a decline after ATT may suggest alternative diagnosis or drug-resistant tuberculosis [13].…”

Prediction of Treatment Outcome with Inflammatory Biomarkers after 2 Months of Therapy in Pulmonary Tuberculosis Patients: Preliminary Results

“…C-reactive protein is a non-specific inflammatory marker that has been proven useful in predicting inflammatory conditions, but with a relatively slow responsive kinetic profile that cannot accurately reflect the bacterial load, hindering its clinical use [5,22]. Reductions in CRP values after the two-month intensive phase treatment have been reported in several studies [23]. Positive correlations have been noted between the decrease in inflammatory markers, such as CRP and IP-10 levels, and the degree of lung involvement [24] and sputum culture conversion [25].…”