C-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study

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dc.contributor.authorMendelson, Fiona
dc.contributor.authorGriesel, Rulan
dc.contributor.authorTiffin, Nicki
dc.contributor.authorRangaka, Molebogeng
dc.contributor.authorBoulle, Andrew
dc.contributor.authorMendelson, Marc
dc.contributor.authorMaartens, Gary
dc.date.accessioned2018-09-10T09:36:45Z
dc.date.available2018-09-10T09:36:45Z
dc.date.issued2018-08-14
dc.date.updated2018-08-19T03:21:46Z
dc.description.abstractBackground Tuberculosis, bacterial community-acquired pneumonia (CAP), and Pneumocystis jirovecii pneumonia (PJP) are the three commonest causes of hospitalisation in HIV-infected adults. Prompt diagnosis and treatment initiation are important to reduce morbidity and mortality, but are hampered by limited diagnostic resources in resource poor settings. C-reactive protein (CRP) and procalcitonin have shown diagnostic utility for respiratory tract infections, however few studies have focussed on their ability to distinguish between tuberculosis, CAP, and PJP in HIV-infected inpatients. Methods We evaluated the diagnostic accuracy of CRP and procalcitonin, compared with composite reference standards, to discriminate between the three target infections in adult HIV-infected inpatients in two district level hospitals in Cape Town, South Africa. Participants were admitted with current cough and danger signs in accordance with the WHO algorithm for tuberculosis in seriously ill HIV-infected patients. Study clinicians were blinded to CRP and procalcitonin results. Results Two hundred forty-eight participants met study case definitions: 133 with tuberculosis, 61 with CAP, 16 with PJP, and 38 with mixed infection. In the 210 particpants with single infections the differences in median CRP and procalcitonin concentrations between the three infections were statistically significant, but distributions overlapped considerably. CRP and procalcitonin concentrations were highest in the CAP group and lowest in the PJP group. CRP and procalcitonin cut-offs with sensitivities of ≥90% were found for all three target infection pairs, but corresponding specificities were low. Highest receiver operating characteristic areas under the curve for CRP and procalcitonin were for PJP versus tuberculosis and PJP versus CAP (0.68 and 0.71, and 0.74 and 0.69 respectively). Conclusions CRP and procalcitonin showed limited value in discriminating between the three target infections due to widely overlapping distributions, but diagnostic accuracy was higher for discriminating PJP from CAP or tuberculosis. Our findings show limitations for CRP and procalcitonin, particularly for discriminiation of tuberculosis form CAP, however they may have greater diagnostic utility as part of a panel of biomarkers or in clinical prediction rules.
dc.identifier.apacitationMendelson, F., Griesel, R., Tiffin, N., Rangaka, M., Boulle, A., Mendelson, M., & Maartens, G. (2018). C-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/28450en_ZA
dc.identifier.chicagocitationMendelson, Fiona, Rulan Griesel, Nicki Tiffin, Molebogeng Rangaka, Andrew Boulle, Marc Mendelson, and Gary Maartens "C-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study." <i>BMC Infectious Diseases</i> (2018) http://hdl.handle.net/11427/28450en_ZA
dc.identifier.citationMendelson, F., Griesel, R., Tiffin, N., Rangaka, M., Boulle, A., Mendelson, M., & Maartens, G. (2018). C-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study. BMC infectious diseases, 18(1), 399.
dc.identifier.ris TY - Journal Article AU - Mendelson, Fiona AU - Griesel, Rulan AU - Tiffin, Nicki AU - Rangaka, Molebogeng AU - Boulle, Andrew AU - Mendelson, Marc AU - Maartens, Gary AB - Background Tuberculosis, bacterial community-acquired pneumonia (CAP), and Pneumocystis jirovecii pneumonia (PJP) are the three commonest causes of hospitalisation in HIV-infected adults. Prompt diagnosis and treatment initiation are important to reduce morbidity and mortality, but are hampered by limited diagnostic resources in resource poor settings. C-reactive protein (CRP) and procalcitonin have shown diagnostic utility for respiratory tract infections, however few studies have focussed on their ability to distinguish between tuberculosis, CAP, and PJP in HIV-infected inpatients. Methods We evaluated the diagnostic accuracy of CRP and procalcitonin, compared with composite reference standards, to discriminate between the three target infections in adult HIV-infected inpatients in two district level hospitals in Cape Town, South Africa. Participants were admitted with current cough and danger signs in accordance with the WHO algorithm for tuberculosis in seriously ill HIV-infected patients. Study clinicians were blinded to CRP and procalcitonin results. Results Two hundred forty-eight participants met study case definitions: 133 with tuberculosis, 61 with CAP, 16 with PJP, and 38 with mixed infection. In the 210 particpants with single infections the differences in median CRP and procalcitonin concentrations between the three infections were statistically significant, but distributions overlapped considerably. CRP and procalcitonin concentrations were highest in the CAP group and lowest in the PJP group. CRP and procalcitonin cut-offs with sensitivities of ≥90% were found for all three target infection pairs, but corresponding specificities were low. Highest receiver operating characteristic areas under the curve for CRP and procalcitonin were for PJP versus tuberculosis and PJP versus CAP (0.68 and 0.71, and 0.74 and 0.69 respectively). Conclusions CRP and procalcitonin showed limited value in discriminating between the three target infections due to widely overlapping distributions, but diagnostic accuracy was higher for discriminating PJP from CAP or tuberculosis. Our findings show limitations for CRP and procalcitonin, particularly for discriminiation of tuberculosis form CAP, however they may have greater diagnostic utility as part of a panel of biomarkers or in clinical prediction rules. DA - 2018-08-14 DB - OpenUCT DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - C-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study TI - C-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study UR - http://hdl.handle.net/11427/28450 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12879-018-3303-6
dc.identifier.urihttp://hdl.handle.net/11427/28450
dc.identifier.vancouvercitationMendelson F, Griesel R, Tiffin N, Rangaka M, Boulle A, Mendelson M, et al. C-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study. BMC Infectious Diseases. 2018; http://hdl.handle.net/11427/28450.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDivision of Clinical Pharmacologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Infectious Diseases
dc.source.urihttps://bmcinfectdis.biomedcentral.com/
dc.subject.otherHIV
dc.subject.otherTuberculosis
dc.subject.otherBacterial community-acquired pneumonia
dc.subject.otherPneumocystis jirovecii pneumonia
dc.subject.otherC-reactive protein
dc.subject.otherProcalcitonin
dc.subject.otherDiagnostic accuracy
dc.subject.otherWHO algorithm
dc.titleC-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study
dc.typeJournal Article
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uct.type.filetypeImage
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