Clinical utility of C-reactive protein-based triage for presumptive pulmonary tuberculosis in South African adults.
Clinical utility of C-reactive protein-based triage for presumptive pulmonary tuberculosis in South African adults.
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DOI：
10.1016/j.jinf.2022.10.041
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发表时间：
2023-01
影响因子：
28.2
通讯作者：
Gupta, Rishi K.
中科院分区：
文献类型：
--
作者：
Calderwood, Claire J.;Reeve, Byron W. P.;Mann, Tiffeney;Palmer, Zaida;Nyawo, Georgina;Mishra, Hridesh;Ndlangalavu, Gcobisa;Abubakar, Ibrahim;Noursadeghi, Mahdad;Theron, Grant;Gupta, Rishi K.
C反应蛋白对有症状的成人肺结核有较好的诊断准确性。在≥10，10毫克/L C反应蛋白接近但未能达到世卫组织结核病分流测试的基准。C反应蛋白仍可提供临床实用价值，优先使用确证试验。包括艾滋病毒携带者在内的结核病关键风险群体的表现相似。C反应蛋白的临床应用取决于目标人群的结核病患病率。在到医疗机构就诊的人群中确定一种准确、低成本的肺结核分诊测试是一项紧迫的全球研究重点。我们评估了C-反应蛋白(CRP)在有症状的成人门诊患者中对结核病分流的诊断准确性和临床实用性，而不考虑HIV状态。我们前瞻性地招募了在南非开普敦的两家结核病诊所报告至少一种或两种咳嗽、发烧、盗汗或体重减轻症状的成年人。参与者提供痰用于培养和Xpert MTB/RIF Ultra。我们评估了C反应蛋白(通过实验室化验测量)与结核培养参考标准(作为受试者工作特征曲线(AUROC)下的面积)的诊断准确性，以及在预先指定的阈值下的敏感性和特异性。我们使用决策曲线分析来评估临床效用，并以世卫组织的建议为基准。在纳入的932人中，255人(27%)患有培养确认的肺结核病，389人(42%)感染艾滋病毒。以≥10 mg/L为初始界值，C-反应蛋白的AUROC为0.80(95%可信区间为0.77-0.83)，敏感性为93%(89-95%)，特异性为54%(50-58%)。在决策曲线分析中，对于愿意对每个确诊的真阳性肺结核病例进行20次确证试验(阈值概率为5%)的所有患者，基于CRP的分诊提供了比确证试验更大的临床效用。如果有可能进行比这更多的验证性测试，那么“所有人的验证性测试”策略表现得更好。CRP达到了WHO定义的肺结核分流测试的灵敏度目标，但没有达到特异度目标，并显示出在有症状的门诊患者中临床有效的证据，而无论HIV状态如何。南非医学研究理事会、EDCTP2、皇家学会牛顿高级奖学金、惠康信托、国家健康研究所、皇家医师学院。
CRP has good diagnostic accuracy for pulmonary TB among symptomatic adults. At ≥10 mg/L CRP approaches, but fails to meet, WHO benchmarks for a TB triage test. CRP may still offer clinical utility to prioritize use of confirmatory tests. Performance is similar across key risk groups for TB including people living with HIV. Clinical utility of CRP is dependent on target population TB prevalence. Identification of an accurate, low-cost triage test for pulmonary TB among people presenting to healthcare facilities is an urgent global research priority. We assessed the diagnostic accuracy and clinical utility of C-reactive protein (CRP) for TB triage among symptomatic adult outpatients, irrespective of HIV status. We prospectively enrolled adults reporting at least one (for people with HIV) or two (for people without HIV) symptoms of cough, fever, night sweats, or weight loss at two TB clinics in Cape Town, South Africa. Participants provided sputum for culture and Xpert MTB/RIF Ultra. We evaluated the diagnostic accuracy of CRP (measured using a laboratory-based assay) against a TB-culture reference standard as the area under the receiver operating characteristic curve (AUROC), and sensitivity and specificity at pre-specified thresholds. We assessed clinical utility using decision curve analysis and benchmarked against WHO recommendations. Of 932 included individuals, 255 (27%) had culture-confirmed pulmonary TB and 389 (42%) were living with HIV. CRP demonstrated an AUROC of 0·80 (95% confidence interval 0·77–0·83), with sensitivity 93% (89–95%) and specificity 54% (50–58%) using a primary cut-off of ≥10 mg/L. Performance was similar among people with HIV to those without. In decision curve analysis, CRP-based triage offered greater clinical utility than confirmatory testing for all up to a number willing to test threshold of 20 confirmatory tests per true positive pulmonary TB case diagnosed (threshold probability 5%). If it is possible to perform more confirmatory tests than this, a ‘confirmatory test for all’ strategy performed better. CRP achieved the WHO-defined sensitivity, but not specificity, targets for a triage test for pulmonary TB and showed evidence of clinical utility among symptomatic outpatients, irrespective of HIV status. South African Medical Research Council, EDCTP2, Royal Society Newton Advanced Fellowship, Wellcome Trust, National Institute of Health Research, Royal College of Physicians.
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DOI：
10.1136/bmj.i6
发表时间：
2016-01-25
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Vickers AJ;Van Calster B;Steyerberg EW
通讯作者：
Steyerberg EW
影响因子：
10
作者：
Chegou, Novel N.;Sutherland, Jayne S.;Walzl, Gerhard
通讯作者：
Walzl, Gerhard
影响因子：
4.7
作者：
Ishikawa, Shizukiyo;Kayaba, Kazunori;Kajii, Eiji
通讯作者：
Kajii, Eiji
影响因子：
5
作者：
SHINE, B;DEBEER, FC;PEPYS, MB
通讯作者：
PEPYS, MB
DOI：
10.1016/s1473-3099(17)30488-7
发表时间：
2017-12
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Yoon C;Semitala FC;Atuhumuza E;Katende J;Mwebe S;Asege L;Armstrong DT;Andama AO;Dowdy DW;Davis JL;Huang L;Kamya M;Cattamanchi A
通讯作者：
Cattamanchi A