Acute Phase Proteins: Old tools improving tuberculosis diagnosis
DOI:
https://doi.org/10.21527/2176-7114.2023.47.13923Keywords:
Tuberculosis; Antitubercular Agents; Acute-Phase ReactionAbstract
Rapid identification of new cases of tuberculosis and monitoring of patients during antituberculosis treatment are important tools for disease control. Thus, the objective of the present study was to evaluate acute phase markers of patients with tuberculosis during antituberculosis treatment and their association with clinical, laboratory and radiological parameters. Therefore, a study with a quantitative approach was carried out, in which, the levels of C-reactive protein (CRP), albumin (ALB) and the CRP/ALB ratio of patients with tuberculosis (n=37) treated in a city in the Western São Paulo region, were evaluated at different times of antituberculosis treatment: T1 (1 and 2 months; n =16), T2 (3 and 4 months; n=11) and T3 (5 and 6 months; n=10) and controls (n=21). The risk of complications from inflammatory stress was associated with different levels of CRP/ALB ratio. Clinical, laboratory and radiological data of patients obtained through analysis of medical records. It was demonstrated that the levels of CRP and CRP/ALB ratio were elevated in T1 compared to T2. The CRP/ALB ratio demonstrated an association with a higher risk of complications from inflammatory stress at T1, with a decreased risk at T2. There was a decrease in CRP and CRP/ALB ratio from T1 to T2 in patients with positive bacilloscopy (1+) and with the presence of fever and other symptoms. We conclude that CRP and CRP/ALB ratio can be used as markers for diagnosis and antituberculosis treatment and the association CRP/ALB ratio with the risk of complications from inflammatory stress in monitoring the effectiveness of the treatment.
References
Global tuberculosis report 2022. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. Disponível em: https://www.who.int/teams/global-tuberculosis-programme/tb-reports
Herrera MT, Guzmán-Beltrán S, Bobadilla K, Santos-Mendoza T, Flores-Valdez MA, Gutiérrez-González LH, et al. Human Pulmonary Tuberculosis: Understanding the Immune Response in the Bronchoalveolar System. Biomolecules. 2022;12:1.148. DOI: 10.3390/biom12081148
Jain S, Gautam V and Naseem S. Acute-phase proteins: As diagnostic tool. J Pharm Bioallied Sci. 2011;3:118-127. DOI: 10.4103/0975-7406.76489
Corrêa CR, Angeleli AYO, Camargo N dos R, Barbosa L, Burini RC. Comparação entre a relação PCR/albumina e o índice prognóstico inflamatório nutricional (IPIN). J Bras Patol Med Lab. 2002;38(3). DOI: 10.1590/S1676-24442002000300004
Fayed HM, Mohammed AE, Badawy MS, Yassin AS. The utility and validity of immunological, inflammatory, and nutritional-based scores and indices in active Pulmonary Tuberculosis. Int Clin Pathol J. 2018;6(6):199-213. DOI: 10.15406/icpjl.2018.06.00188
Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. Journal of clinical medicine, 2018;7(10):333. DOI: 10.3390/jcm7100333
Kalabin A, Mani VR, Valdivieso SC, Donaldson B. Does C reactive protein/Albumin ratio have prognostic value in patients with COVID-19. J Infect Dev Ctries. 2021;15:1.086-1.093. DOI: 10.3855/jidc.14826
Özcan S, Dönmez E, Yavuz Tuğrul S, Şahin İ, İnce O, Ziyrek M, et al. The Prognostic Value of C-Reactive Protein/Albumin Ratio in Acute Pulmonary Embolism. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutrición. 2022;74(2):097-103. DOI: 10.24875/RIC.21000547
Wiegert EVM, Lima LC, Cunha GC, Fonseca TSM, Silva GA, Oliveira LC. Changes in inflammatory biomarkers related to C-reactive protein and albumin in patients with terminal cancer receiving palliative care: a longitudinal study. Braz J Oncol. 2022;18:e-20220349. DOI: 10.5935/2526-8732.20220349
Zavalaga-Zegarra HJ, Palomino-Gutierrez JJ, Ulloque-Badaracco JR, Mosquera-Rojas MD, Hernandez-Bustamante EA, Alarcon-Braga EA, et al. C-Reactive Protein-to-Albumin Ratio and Clinical Outcomes in COVID-19 Patients: A Systematic Review and Meta-Analysis. Trop. Med. Infect. Dis. 2022;7:186. DOI: 10.3390/tropicalmed7080186
Uzum Y, Turkkan E. Predictivity of CRP, Albumin, and CRP to Albumin Ratio on the Development of Intensive Care Requirement, Mortality, and Disease Severity in Covid-19. Cureus. 2023;15(1):e33600. DOI: 10.7759/cureus.33600
Silva DR, Rabahi MF, Sant’Anna CC, Silva-Junior JLR, Capone D, Bombarda S, et al. Diagnosis of tuberculosis: a consensus statement from the Brazilian Thoracic Association. J Bras Pneumol. 2021;47(2):e20210054. DOI: 10.36416/1806-3756/e20210054
Armstrong-Hough M, Ggita J, Turimumahoro P, Meyer AJ, Ochom E, Dowdy D, Cattamanchi A, Katamba A, Davis JL. “Something so hard”: a mixed-methods study of home sputum collection for tuberculosis contact investigation in Uganda. Int J Tuber Lung Dis. 2018;22:1.152-1.159. DOI: 10.5588/ijtld.18.0129
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Manual de Recomendações para o Controle da Tuberculose no Brasil. Brasília: Ministério da Saúde; 2019.
Moraes ML, Ramalho DM, Delogo KN, Miranda PF, Mesquita ED, Oliveira HM, et al. Association between serum selenium level and conversion of bacteriological tests during antituberculosis treatment. J Bras Pneumol. 2014;40(3):269-278. DOI: 10.1590/s1806-37132014000300010
Moraes ML, Ramalho DM, Delogo KN, Miranda PF, Mesquita ED, de Melo Guedes de Oliveira HM, et al. Association of serum levels of iron, copper, and zinc, and inflammatory markers with bacteriological sputum conversion during tuberculosis treatment. Biol Trace Elem Res. 2014;160(2):176-184. DOI: 10.1007/s12011-014-0046-0
Wang C, Wei LL, Shi LY, Pan ZF, Yu XM, Li TY, et al. Screening and identification of five serum proteins as novel potential biomarkers for cured pulmonary tuberculosis. Sci Rep. 2015;26;5:15.615. DOI: 10.1038/srep15615
Moreira FMF, Verma, R., Pereira Dos Santos PC, Leite A, da Silva Santos A, de Araujo RCP, et al. Blood-based host biomarker diagnostics in active case finding for pulmonary tuberculosis: A diagnostic case-control study. EClinicalMedicine. 2021;33:100.776. DOI: 10.1016/j.eclinm.2021.100776
Sharma KR, Sharma R, Sharma N, Sandhu R, Sharma A, Mahajan C, et al. Study of the Serum Levels of C-Reactive Proteins as an Indicator of Disease Activity in Pulmonary Tuberculosis and Monitoring Response to treatment. Ann. Int. Med. Den. Res. 2016;6:23-27. DOI: 10.21276/aimdr.2016.2.6.ME6
Khalil MM, Halim HA, Abdelazeem MS. C-reactive protein versus erythrocyte sedimentation rate in monitoring multidrug-resistant tuberculosis. Egypt J Chest Dis Tuberc. 2020;69:458-65. DOI: 10.4103/ejcdt.ejcdt_113_19
Calderwoo, CJ, Reeve BW, Mann T, Palmer Z, Nyawo G, Mishra H, et al. Clinical utility of C-reactive protein-based triage for presumptive pulmonary tuberculosis in South African adults. The Journal of infection, 2023;86(1):24-32. DOI: 10.1016/j.jinf.2022.10.041
Meyer AJ, Ochom E, Turimumahoro P, Byanyima P, Sanyu I, Lalitha R, et al. C-reactive protein testing for active tuberculosis among inpatients without HIV in Uganda: a diagnostic accuracy study. J Clin Microbiol. 2021;59:e02162-20. DOI: 10.1128/JCM.02162-20
Samuels THA, Wyss R, Ongarello S, Moore DAJ, Schumacher SG, Denkinger CM. Evaluation of the diagnostic performance of laboratory-based c-reactive protein as a triage test for active pulmonary tuberculosis. PLoS ONE. 2021;16(7):e0254002. DOI: 10.1371/journal.pone.0254002
Saripalli A, Ramapuram J. C-Reactive Protein as a Screening Test for Tuberculosis in People Living with HIV in Southern India: A Cross-Sectional, Observational Study. J. Clin. Med. 2022;11:3566. DOI: 10.3390/jcm11133566
Liu R, Shu W, Song Y, Liu Y, Ma L, Gao M. Use of Serum Albumin Level as a Predictive Marker of Clinical Outcomes for Active Tuberculosis. Annals of clinical and laboratory science. 2020;50(5):681-686.
Maranatha D, Krisdanti DPA. The factors predicting mortality in pulmonary tuberculosis with acute respiratory failure. Clinical Epidemiology and Global Health. 2021;12:100.843. DOI: 10.1016/j.cegh.2021.100843
Sadsyam S, Djabir YY, Santoso A. Correlation of low body mass index and albumin level with the presence of liver dysfunction in newly diagnosed tuberculosis patients. Sasambo Journal of Pharmacy,. 2021;2(2):51-54. DOI: 10.29303/sjp.v2i2.105
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Revista Contexto & Saúde
This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Revista Contexto & Saúde, authors agree to the following terms:
The works are licensed under the Creative Commons Atribuição 4.0 Internacional (CC BY 4.0) license, which allows:
Share — to copy and redistribute the material in any medium or format;
Adapt — to remix, transform, and build upon the material for any purpose, including commercial.
These permissions are irrevocable, provided that the following terms are respected:
Attribution — authors must be properly credited, with a link to the license and indication of any changes made.
No additional restrictions — no legal or technological measures may be applied that restrict the use permitted by the license.
Notes:
The license does not apply to elements in the public domain or covered by legal exceptions.
The license does not grant all rights necessary for specific uses (e.g., image rights, privacy, or moral rights).
The journal is not responsible for opinions expressed in the articles, which are the sole responsibility of the authors. The Editor, with the support of the Editorial Board, reserves the right to suggest or request modifications when necessary.
Only original scientific articles presenting research results of interest that have not been published or simultaneously submitted to another journal with the same objective will be accepted.
Mentions of trademarks or specific products are intended solely for identification purposes, without any promotional association by the authors or the journal.
License Agreement (for articles published from September 2025): Authors retain copyright over their article and grant Revista Contexto & Saúde the right of first publication.
