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Reviews of "C-reactive Protein-Based Tuberculosis Triage Testing: A Multi-Country Diagnostic Accuracy Study"

Reviewers: N Heinrich (Ludwig-Maximilians-University of Munich) | πŸ“˜πŸ“˜πŸ“˜πŸ“˜πŸ“˜ β€’ D Goletti (National Institute for Infectious Deseases) | πŸ“˜πŸ“˜πŸ“˜πŸ“˜πŸ“˜

Published onOct 03, 2024
Reviews of "C-reactive Protein-Based Tuberculosis Triage Testing: A Multi-Country Diagnostic Accuracy Study"
key-enterThis Pub is a Review of
C-reactive protein-based tuberculosis triage testing: a multi-country diagnostic accuracy study
C-reactive protein-based tuberculosis triage testing: a multi-country diagnostic accuracy study
Description

ABSTRACT Rationale C-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV (PWH). However, its performance among people without HIV and in diverse settings is unknown.Objectives In a multi-country study, we aimed to determine whether CRP meets the minimum accuracy targets (sensitivity β‰₯90%, specificity β‰₯70%) for an effective TB triage test.Methods/Measurements Consecutive outpatient adults with cough β‰₯2 weeks from five TB endemic countries in Africa and Asia had baseline blood collected for point-of-care CRP testing and HIV and diabetes screening. Sputum samples were collected for Xpert MTB/RIF Ultra (Xpert) testing and culture. CRP sensitivity and specificity (5 mg/L cut-point) was determined in reference to sputum test results and compared by country, sex, and HIV and diabetes status. Variables affecting CRP performance were identified using a multivariate receiver operating characteristic (ROC) regression model.Results Among 2904 participants, of whom 613 (21%) had microbiologically-confirmed TB, CRP sensitivity was 84% (95% CI: 81-87%) and specificity was 61% (95% CI: 59-63%). CRP accuracy varied geographically, with higher sensitivity in African countries (β‰₯91%) than Asian countries (64-82%). Sensitivity was higher among men than women (87% vs. 79%, difference +8%, 95% CI: 1-15%) and specificity was higher among people without HIV than PWH (64% vs. 45%, difference +19%, 95% CI: 13-25%). ROC regression identified country and measures of TB disease severity as predictors of CRP performance.Conclusions Overall, CRP did not achieve the minimum accuracy targets and its performance varied by setting and in some sub-groups, likely reflecting population differences in mycobacterial load.

To read the original manuscript, click the link above.

Summary of Reviews: This study evaluated the diagnostic accuracy of C-reactive protein (CRP) as a screening tool for tuberculosis (TB) in symptomatic individuals from several countries across Africa and Asia. CRP was tested against sputum analysis (Xpert MTB/RIF and culture) and did not meet the minimum accuracy thresholds (sensitivity β‰₯90%, specificity β‰₯70%) for an effective TB triage test. Reviewers found this study robust and informative, suggesting only minor improvements, such as following up with individuals with a negative sputum analysis. This research reinforces the need for better triage tools for TB.

Reviewer 1 (Norbert H…) | πŸ“˜πŸ“˜πŸ“˜πŸ“˜πŸ“˜

Reviewer 2 (Delia G…) | πŸ“˜πŸ“˜πŸ“˜πŸ“˜πŸ“˜

RR\ID Strength of Evidence Scale Key

πŸ“• ◻️◻️◻️◻️ = Misleading

πŸ“™πŸ“™ ◻️◻️◻️ = Not Informative

πŸ“’πŸ“’πŸ“’ ◻️◻️ = Potentially Informative

πŸ“—πŸ“—πŸ“—πŸ“—β—»οΈ = Reliable

πŸ“˜πŸ“˜πŸ“˜πŸ“˜πŸ“˜ = Strong

To read the reviews, click the links below.Β 

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