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C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review

OBJECTIVES: C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers in high-income countries. However, evidence for their use in low- and middle-income countries (LMICs) is scant. Because many factors, including rates of endemic disease, comorbidities and genetics, may influence...

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Autores principales: Lamrous, Amin, Repetto, Ernestina, Depp, Tim, Jimenez, Carolina, Chua, Arlene C, Kanapathipillai, Rupa, Jensen, Tomas O
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10190046/
https://www.ncbi.nlm.nih.gov/pubmed/37206308
http://dx.doi.org/10.1093/jacamr/dlad057
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author Lamrous, Amin
Repetto, Ernestina
Depp, Tim
Jimenez, Carolina
Chua, Arlene C
Kanapathipillai, Rupa
Jensen, Tomas O
author_facet Lamrous, Amin
Repetto, Ernestina
Depp, Tim
Jimenez, Carolina
Chua, Arlene C
Kanapathipillai, Rupa
Jensen, Tomas O
author_sort Lamrous, Amin
collection PubMed
description OBJECTIVES: C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers in high-income countries. However, evidence for their use in low- and middle-income countries (LMICs) is scant. Because many factors, including rates of endemic disease, comorbidities and genetics, may influence biomarkers’ behaviour, we aimed to review available evidence generated in LMICs. METHODS: We searched the PubMed database for relevant studies within the last 20 years that originated in regions of interest (Africa, Latin America, Middle East, South Asia or South East Asia), and full-text articles involving diagnosis, prognostication and evaluation of therapeutic response with CRP and/or PCT in adults (n = 88) were reviewed and categorized in 12 predefined focus areas. RESULTS: Overall, results were highly heterogeneous, at times conflicting, and often lacking clinically useful cut-off values. However, most studies demonstrated higher levels of CRP/PCT in patients with bacterial versus other infections. HIV and TB patients had consistently higher levels of CRP/PCT versus controls. In addition, higher CRP/PCT levels at baseline and follow-up in HIV, TB, sepsis and respiratory tract infections were associated with poorer prognosis. CONCLUSIONS: Evidence generated from LMIC cohorts suggests that CRP and PCT may have potential to become effective clinical guiding tools particularly in respiratory tract infections, sepsis and HIV/TB. However, more studies are needed to define potential scenarios for use and cost-effectiveness. Consensus across stakeholders regarding target conditions, laboratory standards and cut-off values would support the quality and applicability of future evidence.
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spelling pubmed-101900462023-05-18 C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review Lamrous, Amin Repetto, Ernestina Depp, Tim Jimenez, Carolina Chua, Arlene C Kanapathipillai, Rupa Jensen, Tomas O JAC Antimicrob Resist Review OBJECTIVES: C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers in high-income countries. However, evidence for their use in low- and middle-income countries (LMICs) is scant. Because many factors, including rates of endemic disease, comorbidities and genetics, may influence biomarkers’ behaviour, we aimed to review available evidence generated in LMICs. METHODS: We searched the PubMed database for relevant studies within the last 20 years that originated in regions of interest (Africa, Latin America, Middle East, South Asia or South East Asia), and full-text articles involving diagnosis, prognostication and evaluation of therapeutic response with CRP and/or PCT in adults (n = 88) were reviewed and categorized in 12 predefined focus areas. RESULTS: Overall, results were highly heterogeneous, at times conflicting, and often lacking clinically useful cut-off values. However, most studies demonstrated higher levels of CRP/PCT in patients with bacterial versus other infections. HIV and TB patients had consistently higher levels of CRP/PCT versus controls. In addition, higher CRP/PCT levels at baseline and follow-up in HIV, TB, sepsis and respiratory tract infections were associated with poorer prognosis. CONCLUSIONS: Evidence generated from LMIC cohorts suggests that CRP and PCT may have potential to become effective clinical guiding tools particularly in respiratory tract infections, sepsis and HIV/TB. However, more studies are needed to define potential scenarios for use and cost-effectiveness. Consensus across stakeholders regarding target conditions, laboratory standards and cut-off values would support the quality and applicability of future evidence. Oxford University Press 2023-05-17 /pmc/articles/PMC10190046/ /pubmed/37206308 http://dx.doi.org/10.1093/jacamr/dlad057 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Review
Lamrous, Amin
Repetto, Ernestina
Depp, Tim
Jimenez, Carolina
Chua, Arlene C
Kanapathipillai, Rupa
Jensen, Tomas O
C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review
title C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review
title_full C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review
title_fullStr C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review
title_full_unstemmed C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review
title_short C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review
title_sort c-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10190046/
https://www.ncbi.nlm.nih.gov/pubmed/37206308
http://dx.doi.org/10.1093/jacamr/dlad057
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