ArticlePloS one2021
Evaluation of the diagnostic performance of laboratory-based c-reactive protein as a triage test for active pulmonary tuberculosis.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Host blood protein biomarkers to screen for tuberculosis disease: a systematic review and meta-analysis.Journal of clinical microbiology · 2024Pooled it
- Screening performance of C-reactive protein for active pulmonary tuberculosis in HIV-positive patients: A systematic review with a meta-analysis.Frontiers in immunology · 2022Pooled it
- Evaluation of C-Reactive Protein and Computer-Aided Analysis of Chest X-rays as Tuberculosis Triage Tests at Health Facilities in Lesotho and South Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Trial
- Hypercoagulability in Pulmonary Tuberculosis: Reduced Protein C and Free Protein S Predict Pulmonary Embolism-Evidence from a Prospective Romanian Cohort.Journal of clinical medicine · 2026Article
- Comparative cost analysis of community-based tuberculosis screening: Computer-Aided Detection (CAD) alone versus CAD with point-of-care C-reactive protein testing in South Africa and Lesotho.PLOS global public health · 2026Article
- Screening and diagnostic strategies for active pulmonary tuberculosis among people in prison in Malaysia: a prospective diagnostic study.The Lancet regional health. Western Pacific · 2025Article
- Article
- Diagnostic accuracy of point-of-care triage tests for pulmonary tuberculosis using host blood protein biomarkers: a systematic review and meta-analysis.EClinicalMedicine · 2025Article
- Advances on Electrochemiluminescent Biosensors for TB Biomarkers.ACS sensors · 2025Review
- C-Reactive Protein-based Screening of People with Tuberculosis Symptoms: A Diagnostic Accuracy Study.American journal of respiratory and critical care medicine · 2025Article
- Accuracy of C-Reactive Protein for Tuberculosis Detection in General-Population Screening and Ambulatory-Care Triage in Uganda.Annals of the American Thoracic Society · 2024Article
- C-reactive protein-based tuberculosis triage testing: a multi-country diagnostic accuracy study.medRxiv : the preprint server for health sciences · 2024Article
- Cost-effectiveness of Low-complexity Screening Tests in Community-based Case-finding for Tuberculosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Predictors contributing to the estimation of pulmonary tuberculosis among adults in a resource-limited setting: A systematic review of diagnostic predictions.SAGE open medicine · 2024Review
- The accuracy of point-of-care C-Reactive Protein as a screening test for tuberculosis in children.PLOS global public health · 2024Article
- Association Between Indices of Peripheral Blood Inflammation and Cavitary Pulmonary Tuberculosis.International journal of general medicine · 2024Article
- Clinical utility of C-reactive protein-based triage for presumptive pulmonary tuberculosis in South African adults.The Journal of infection · 2023Article
- Article
- The Role of C-Reactive Protein as a Triage Tool for Pulmonary Tuberculosis in Children.Journal of the Pediatric Infectious Diseases Society · 2022Article
- Reimagining the status quo: How close are we to rapid sputum-free tuberculosis diagnostics for all?EBioMedicine · 2022Review
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionA highly sensitive triage test that captures most symptomatic patients at increased likelihood of having pulmonary tuberculosis (PTB) would 'rule-out' lower-risk patients from expensive confirmatory testing. Although studies have assessed the diagnostic accuracy of a C-reactive protein (CRP) triage test for PTB in HIV+ patients, limited data are available from HIV- cohorts. MATERIALS AND
methodsIn this retrospective case-control study, 765 serum samples were selected from FIND's biobank. Each sample had been collected from an adult presenting with respiratory symptomatology to district hospitals in South Africa and referral hospitals in Cambodia, Peru, Georgia and Vietnam between 2007-2017. Serum CRP measurements were obtained using a laboratory-based assay. CRP cutoff-points of ≥8mg/L and ≥10mg/L were predefined as a positive triage test result. The PTB reference standard was two contemporaneously collected sputum liquid culture results.
resultsCRP demonstrated an overall sensitivity for PTB of 79.8% (95%CI 75.5-83.5) and 77.7% (95%CI 73.4-81.6) for cutoff-points of 8mg/L and 10mg/L respectively. Specificity was 62.8% (95%CI 57.8-67.6%) and 66.6% (95%CI 61.1-70.7) respectively. Area-under-the-curve using Receiver Operating Characteristic analysis was 0.77 (95%CI 0.74-0.81). Threshold analysis showed optimal CRP cutoff-points were higher in HIV+ than HIV- participants. An algorithm in which CRP triage was followed by confirmatory Xpert MTB/Rif testing achieved a sensitivity of 75.1% (95%CI 69.0-80.4%) whilst decreasing Xpert usage by 40.6%. DISCUSSION: CRP may not meet the challenge of a catch-all TB triage test. However, it shows promise in HIV+ individuals. Further research is required in a prospective study using point-of-care platforms to further evaluate its capabilities.
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