Performance of C-reactive protein, haemoglobin, and albumin as TB/HIV triage tests in hospitalised adults

BACKGROUND Mortality from inpatient TB/HIV is high, and C-reactive protein (CRP) is a suboptimal triaging test. Haemoglobin and albumin and may have additional utility. METHODS We enrolled hospitalised adults evaluated for presumptive TB/HIV and used optimised cut-off values to determine the performance of CRP, haemoglobin, and albumin in triaging for TB/HIV after urine lipoarabinomannan (LAM) testing. RESULTS Four hundred and thirty-nine participants were evaluated. Of the 293 participants with complete results, haemoglobin and albumin levels below the cut-off values were independently associated with LAM-positive TB (adjusted odds ratios: 6.1 [95% confidence interval (CI): 2.6; 15.4] and 5.5 [95% CI: 1.6; 25.0], respectively), but not CRP above the cut-off value (adjusted odds ratio: 2.2 [95% CI: 0.8; 6.6]). If haemoglobin and albumin cut-offs were met, the odds ratio for LAM-positive TB was 17.0 (95% CI: 7.6; 38.0), sensitivity 0.72 (95% CI: 0.56; 0.84), and specificity 0.86 (95% CI: 0.82; 0.91); and the odds ratio was 3.5 (95% CI: 1.4; 8.5) for LAM-negative TB, sensitivity 0.35 (95% CI 0.19; 0.55), and specificity 0.87 (95% CI 0.81; 0.91). CONCLUSION Haemoglobin and albumin performed better than CRP as an inpatient TB/HIV triage test. .