Acute phase proteins and IP-10 as triage tests for the diagnosis of tuberculosis: systematic review and meta-analysis

V. S. Santos, D. Goletti, K. Kontogianni, E. R. Adams, B. Molina-Moya, J. Dominguez, V. Crudu, P. R. S. Martins-Filho, M. Ruhwald, L. Lawson, J. S. Bimba, A. L. Garcia-Basteiro, L. Petrone, B. S. Kabeer, K. Reither, L. E. Cuevas

Research output: Contribution to journalArticle*Academicpeer-review


Objectives: We examined the data reported in studies for diagnostic purposes and to discuss whether their intended use could be extended to triage, as rule-in or rule-out tests to select individuals who should undergo further confirmatory tests. Methods: We searched Scopus, PubMed and Web of Science with the terms ‘acute phase proteins,’ ‘IP-10,’ ‘tuberculosis,’ ‘screening’ and ‘diagnosis,’ extracted the sensitivity and specificity of the biomarkers and explored methodologic differences to explain performance variations. Summary estimates were calculated using random-effects models for overall pooled accuracy. The hierarchical summary receiver operating characteristic model was used for meta-analysis. Results: We identified 14, four and one studies for C-reactive protein (CRP), interferon γ–induced protein 10 (IP-10) and alpha-1-acid glycoprotein (AGP). The pooled CRP sensitivity/specificity (95% confidence interval) was 89% (80–96) and 57% (36–65). Sensitivity/specificity were higher in high-tuberculosis-burden countries (90%/64%), HIV-infected individuals (91%/61%) and community-based studies (90%/62%). IP-10 sensitivity/specificity in TB vs. non-TB studies was 85%/63% and in TB and HIV coinfected vs. other lung conditions 94%/21%. However, IP-10 studies included diverse populations and a high risk of bias, resulting in very low-quality evidence. AGP had 86%/93% sensitivity/specificity. Conclusions: Few studies have evaluated CRP, IP-10 and AGP for the triage of symptomatic patients. Their high sensitivity and moderate specificity warrant further prospective studies exploring whether their combined use could optimize performance.
Original languageEnglish
Pages (from-to)169-177
JournalClinical microbiology and infection
Early online date2018
Publication statusPublished - 2019

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