Evaluation of tuberculosis treatment response with serial C-reactive protein measurements

Wilson, Douglas; Moosa, Mahomed-Yunus S.; Cohen, Ted; Cudahy, Patrick; Aldous, Colleen; Maartens, Gary

doi:10.1101/400572

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…Various clinical algorithms have been developed and assessed for management of TB, however these present shortcomings in HIV positive patients [24,27]. Recent studies suggested that CRP presents higher speci city values and a better performance for identi cation of active PTB, than WHO symptoms-screening strategies [15,28,36]. In line with that, our results demonstrate that CRP is an adequate screening test in regions with high prevalence of HIV infections.…”

Section: Discussionsupporting

confidence: 83%

“…As WHO recommends, people infected with HIV or living with HIV, should be systematically screened for active TB through WHO-4SS assessment or chest radiography evaluation as a second screen test [11,36,37]. Further clinical diagnostic is established by different algorithms: mycobacterial culture, SSM and Xpert MTB/RIF test [11,37].…”

Section: Discussionmentioning

confidence: 99%

“…Although recent research indicates the use of immunological marker CRP as speci c enough for distinguished TB diagnosis, this acute-phase protein can be especially relevant for monitoring the severity of the disease or the effectiveness of the treatment [16,31,32,34]. CRP can be instantly POC measured, saving time and without posing economic burden in comparison with TB symptoms screening test or other molecular tests [16,28,31,36]. On the other hand, the faster PTB is diagnosed, the lower severity and mortality caused by this infection, especially in high-risk groups (such as HIV-infected patients) [15,26,28,31,38].…”

Section: Discussionmentioning

confidence: 99%

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Screening Performance of C-Reactive Protein for Active Pulmonary Tuberculosis in HIV-Positive Patients: A Meta-analysis

Meca

Bogdan

Turcu-Știolică

et al. 2020

Preprint

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Background: Tuberculosis (TB) is the leading infectious cause of mortality worldwide. In the last years, resistant strains of the etiological agent, Mycobacterium tuberculosis, have emerged, thus demanding more triage tests to identify active pulmonary TB (PTB) patients and to evaluate their disease severity. Therefore, acute-phase reaction serum tests are required for monitoring TB patients, among WHO symptoms screening recommendations. C-reactive protein (CRP) is a non-specific inflammatory biomarker that has been recently proposed for TB screening and can be quantitatively analyzed through cost-effective point-of-care assays. A previous meta-analysis found CRP high sensitive and moderate specific for active pulmonary TB with confirmed HIV infection. Methods: We performed an update meta-analysis of diagnostic tests, pooling sensitivities and specificities in order to assess the accuracy of CRP as a potential test for the screening of HIV-associated PTB in outpatients. We searched MEDLINE, Web of Science, and SCOPUS, for eligible articles before April 1st, 2020. Results: We identified 9 eligible studies with HIV-positive patients with PTB. At CRP threshold of 10mg/L, CRP pooled sensitivity was 86% and pooled specificity was 73%. Using CRP threshold of 8mg/L, pooled sensitivity was 81% and pooled specificity was 88%. We found that CRP has a high sensitivity in screening of PTB in HIV-positive outpatients, consistent with findings reported previously. Conclusions: Regardless of pooled specificity, better results were found using the CRP threshold of 8mg/L as a test screening of PTB, meeting the need of evaluation of antituberculosis treatment outcomes and reducing resource consumption.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Screening Performance of C-Reactive Protein for Active Pulmonary Tuberculosis in HIV-Positive Patients: A Meta-analysis

Meca

Bogdan

Turcu-Știolică

et al. 2020

Preprint

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“…Elevated systemic inflammatory markers, such as C-reactive protein (CRP), total white blood cell count (WBC), and neutrophil–lymphocyte ratio (NL ratio), are elevated and predict poor outcomes in ASCVD patients 12 – 16 . CRP and other inflammatory markers also correlate with sputum mycobacterial load 17 , and portend a poor prognosis 18 and increased mortality 19 – 22 in TB patients. Thus, there is a need to assess the potential role of systemic inflammation in the association between pre-existing ASCVD and TB treatment outcomes.…”

Section: Introductionmentioning

confidence: 99%

The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis

Chidambaram

Castillo

Kumar

et al. 2021

Sci Rep

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Tuberculosis (TB) and atherosclerotic cardiovascular disease (ASCVD) have a close epidemiological and pathogenetic overlap. Thus, it becomes essential to understand the relationship between ASCVD and TB outcomes. From our retrospective cohort on drug-susceptible TB patients at the National Taiwan University Hospital, we assessed the association of pre-existing ASCVD (coronary artery disease (CAD) and atherothrombotic stroke (ATS)) with 9-month all-cause and infection-related mortality and the extent of mediation by systemic inflammatory markers. We determined the effect of pre-existing ASCVD on 2-month sputum microbiological status. Among ASCVD patients, we assessed the association of statin use on mortality. Nine-month all-cause mortality was higher in CAD patients with prior acute myocardial infarction (CAD+AMI+) (adjusted HR 2.01, 95%CI 1.38–3.00) and ATS patients (aHR 2.79, 95%CI 1.92–4.07) and similarly, for infection-related mortality was higher in CAD+AMI+ (aHR 1.95, 95%CI 1.17–3.24) and ATS (aHR 2.04, 95%CI 1.19–3.46) after adjusting for confounding factors. Pre-existing CAD (AMI- or AMI+) or ATS did not change sputum culture conversion or sputum smear AFB positivity at 2 months. The CAD+AMI+ group had significantly higher levels of CRP at TB diagnosis in the multivariable linear regression analysis (Adjusted B(SE) 1.24(0.62)). CRP mediated 66% (P = 0.048) and 25% (P = 0.033) of the association all-cause mortality with CAD+AMI− and CAD+AMI+, respectively. In summary, patients with ASCVD have higher hazards of 9-month all-cause and infection-related mortality, with elevated serum inflammation mediating one to three-quarters of this association when adjusted for confounders. Statin use was associated with lower all-cause mortality among patients with ASCVD.

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Evaluation of tuberculosis treatment response with serial C-reactive protein measurements

Cited by 2 publications

References 25 publications

Screening Performance of C-Reactive Protein for Active Pulmonary Tuberculosis in HIV-Positive Patients: A Meta-analysis

Screening Performance of C-Reactive Protein for Active Pulmonary Tuberculosis in HIV-Positive Patients: A Meta-analysis

The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis

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