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

Abstract 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 1 st , 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.