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Predictive value of C-reactive protein for tuberculosis, bloodstream infection or death among HIV-infected individuals with chronic, non-specific symptoms and negative sputum smear microscopy.

Predictive value of C-reactive protein for tuberculosis, bloodstream infection or death among HIV-infected individuals with chronic, non-specific symptoms and negative sputum smear microscopy.
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Bedell RA, van Lettow M, Meaney C, Corbett EL, Chan AK, Heyderman RS, Anderson ST, Åkesson A, Kumwenda M, Zachariah R, Harries AD, Ramsay AR,


Bedell RA, van Lettow M, Meaney C, Corbett EL, Chan AK, Heyderman RS, Anderson ST, Åkesson A, Kumwenda M, Zachariah R, Harries AD, Ramsay AR, (click to view)

Bedell RA, van Lettow M, Meaney C, Corbett EL, Chan AK, Heyderman RS, Anderson ST, Åkesson A, Kumwenda M, Zachariah R, Harries AD, Ramsay AR,

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Tropical medicine & international health : TM & IH 2017 12 15() doi 10.1111/tmi.13025

Abstract
BACKGROUND
To determine whether C-reactive protein (CRP) is an inflammatory biomarker that may identify patients at risk of infections or death. Mortality among HIV-infected persons commencing antiretroviral therapy (ART) is often attributed to tuberculosis (TB) or bloodstream infections (BSI).

METHODS
In two district hospitals in southern Malawi we recruited HIV-infected adults with one or more unexplained symptoms present for at least one month (weight loss, fever, or diarrhea), and negative expectorated sputum microscopy for TB. CRP determination for 452/469 (96%) participants at study enrolment was analyzed for associations with TB, BSI or death to 120 days post-enrolment.

RESULTS
Baseline CRP was significantly elevated among patients with confirmed and probable TB (52), BSI (50) or death (60) compared to those with no identified infection who survived at least 120 days (269). A CRP value of >10 mg/L was associated with confirmed and probable TB (adjusted odds ratio 5.7; 95% CI 2.6, 14.3; 87% sensitivity) or death by 30 days (adjusted odds ratio 9.2; 95% CI 2.2, 55.1; 88% sensitivity). CRP was independently associated with TB, BSI or Death but prediction of these endpoints was enhanced by including hemoglobin (all outcomes), CD4 count (BSI, death), and whether ART was started (death) in logistic regression models.

CONCLUSION
High CRP at the time of ART initiation is associated with TB, BSI and early mortality, and so has potential utility for stratifying patients for intensified clinical and laboratory investigation and follow-up. They may also be considered for empirical treatment of opportunistic infections including TB. This article is protected by copyright. All rights reserved.

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