Table 1.
Overview of Publications From Sub-Saharan Africa Assessing the Diagnostic and Prognostic Value of CRP and PCT Biomarkers to Differentiate Bacterial vs Nonbacterial Infections in Acute Infectious Episodes
| Ref | Study Population/Period | Outcome of Interest | Cutoff, mg/La | Sensitivity, % | Specificity, % | Diagnostic ROC AUC | Comments |
|---|---|---|---|---|---|---|---|
| [24] | Rural Mozambique hospitalized children aged <5 y with severe clinical pneumonia (total n meeting inclusion criteria = 835; 9/2006–9/2007), malaria excluded from analysis | Malaria (-) bacterial (BC+; n = 82) vs viral pneumonia (n = 64) | Malaria (-) | Malaria (-) | AUC for mortality (11%) in malaria (-) | ||
| CRP: 20.9 | 95 | 54.2 | CRP: 0.87 | CRP: 0.64 | |||
| PCT: 0.72 | 94.6 | 74.2 | PCT: 0.90 | PCT: 0.64 | |||
| Test: automated analyzer (for both CRP and PCT) | |||||||
| [37] | Rural Mozambique hospitalized children aged <5 y with severe clinical pneumonia but no malaria (total n meeting inclusion criteria = 653, n all samples available = 586; 9/2006–9/2007) | BC+ (n = 84) vs BC- (n = 246) | PCT | 0.80 | Test: automated analyzer (for both CRP and PCT) | ||
| 0.64 | 95 | 56 | |||||
| 0.83 | 90 | 60 | |||||
| 1.02 | 85 | 62 | |||||
| 1.15 | 80 | 63 | |||||
| 1.4 | 75 | 64 | |||||
| CRP | 0.79 | Mortality of 13%; 30% HIV coinfection (but missing for 120/330) | |||||
| 20.9 | 95 | 45 | |||||
| 27.9 | 90 | 50 | |||||
| 38 | 85 | 57 | |||||
| 59.8 | 80 | 66 | |||||
| 73 | 75 | 68 | |||||
| [38] | Rural Tanzania; OPD; febrile children aged <5 y (total n meeting inclusion criteria = 867, n all samples available = 660; 1–10/2013) | BC+ (n = 17) vs BC- (n = 643) | CRP: 37.3 | 74.2 | 77.8 | 0.83 | 45/56 malaria cases had CRP >40 mg/dL; test: automated analyzer |
| [39] | Rural Tanzania; OPD; children aged <5 y with nonsevere febrile illness & malaria (-) (n included = 428; 7/2011–11/2012) | All bacterial infections (n = 90) | CRP: 19 | 44.6 | 78.5 | 0.62 | Test: POC No. 34, CRP (Supplementary Table 1) |
| UTI (n = 24) | 57.1 | 78.4 | 0.62 | ||||
| Bacteremia (n = 6) | 50.0 | 78.5 | 0.60 | ||||
| IMCI pneumonia (n = 60) vs nonbacterial (n = 341) | 37.5 | 78.5 | 0.60 | ||||
| [35] | Urban Malawi, referral hospital; children aged <16 y with suspected meningitis (n included = 282) or pneumonia (n = 95; 4/2004–10/2006) | Serious bacterial infection (n = 280), vs no detectable bacterial infection (n = 97) | CRP | - | - | 0.81 | HIV 50%; malaria 4% |
| PCT | - | - | 0.86 | AUC for mortality (22%): CRP: 0.43; PCT 0.61 | |||
| Test: PCT: sandwich immuno-assay; CRP: automated analyzer | |||||||
| [40] | Tanzania (1 rural, 1 urban center); OPD; children aged <10 y with clinical pneumonia (n included = 155), malaria excluded from analysis (4–12/2008) | End point pneumonia (n = 30) vs normal x-ray (n = 94) | CRP: 44.1 | 80.0 | 78.7 | 0.85 | Cutoff with highest combined sensitivity/ specificity; test: CRP and PCT: ELISA |
| PCT: 0.51 | 70.0 | 69.2 | 0.70 | ||||
| [41] | Multicountry (South Africa, Zambia, Kenia, Gambia, Mali, Bangladesh, Thailand), 9 sites in urban and rural settings | Confirmed bacterial pneumonia (n = 145; 119 HIV-; 26 HIV+) vs RSV pneumonia (n = 567; 556 HIV-; 11 HIV+) | CRP: 37.1 | 77 | 82 | 0.87 | Proportion among different sites, study period not mentioned in the study |
| Hospitalized children aged <5 y, with WHO criteria for severe or very severe pneumonia (n included with CRP results = 3357 HIV-, 240 HIV+) | Test: CRP: automated analyzer | ||||||
| [42] | South Africa, referral hospital; hospitalized children aged <5 y with severe pneumonia (n meeting inclusion criteria = 570; 3/97–8/98) | Bacteremic pneumonia (n = 50) and pneumonia of mixed etiology (n = 10) vs viral pneumonia (n = 146) and pneumonia of undefined pneumonia (n = 364) | CRP: 10 | 92.4 | 28.2 | 0.8 (0.83 in HIV+, 0.72 in HIV-) | 42.8% HIV+ (recorded in 514/570 children) |
| CRP: 40 | 75.8 | 59.9 | Test: CRP automated analyzer | ||||
| [43] | Tanzania, 2 hospitals; in- and outpatients with history of/documented fever, all ages (n with available CRP results = 804; 9/2011–5/2014) | Bacterial bloodstream infection (n = 31) | CRP: 10 | 97 | N/A | N/A | Self-reported HIV infection (18.4%); 2 patients with bacterial infection co-infected with Plasmodium falciparum; test: CRP automated analyzer |
| CRP: 20 | 94 | ||||||
| CRP: 40 | 90 | ||||||
| Bacterial zoonosis (n = 61) | CRP: 10 | 87 | |||||
| CRP: 20 | 82 | ||||||
| CRP: 40 | 72 |
Abbreviations: BC, blood culture; CRP, C-reactive protein; IMCI, integrated management of childhood illness; OPD, outpatient department; POC, point of care; PCT, procalcitonin; ROC AUC, receiver operating characteristics area under the curve.
aUnits: CRP: mg/L; PCT: µg/L.