{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T08:25:19Z","timestamp":1765959919057},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,1,4]],"date-time":"2018-01-04T00:00:00Z","timestamp":1515024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100005850","name":"International Union Against Tuberculosis and Lung Disease","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005850","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>C\u2010reactive protein (<jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content>) is an inflammatory biomarker that may identify patients at risk of infections or death. Mortality among <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected persons commencing antiretroviral therapy (<jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>) is often attributed to tuberculosis (<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>) or bloodstream infections (<jats:styled-content style=\"fixed-case\">BSI<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In two district hospitals in southern Malawi, we recruited <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected adults with one or more unexplained symptoms present for at least one month (weight loss, fever or diarrhoea) and negative expectorated sputum microscopy for <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> determination for 452 of 469 (96%) participants at study enrolment was analysed for associations with <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> BSI<\/jats:styled-content> or death to 120 days post\u2010enrolment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> was significantly elevated among patients with confirmed or probable <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> (52), <jats:styled-content style=\"fixed-case\">BSI<\/jats:styled-content> (50) or death (60) compared to those with no identified infection who survived at least 120 days (269). A <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> value of &gt;10 mg\/L was associated with confirmed or probable <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> (adjusted odds ratio 5.7; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.6, 14.3; 87% sensitivity) or death by 30 days (adjusted odds ratio 9.2; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.2, 55.1; 88% sensitivity). <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> was independently associated with <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> BSI<\/jats:styled-content> or death, but the prediction of these endpoints was enhanced by including haemoglobin (all outcomes), <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count (<jats:styled-content style=\"fixed-case\">BSI<\/jats:styled-content>, death) and whether <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> was started (death) in logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> at the time of <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> initiation is associated with <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> BSI<\/jats:styled-content> and early mortality and so has potential utility for stratifying patients for intensified clinical and laboratory investigation and follow\u2010up. They may also be considered for empirical treatment of opportunistic infections including <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13025","type":"journal-article","created":{"date-parts":[[2017,12,16]],"date-time":"2017-12-16T21:36:02Z","timestamp":1513460162000},"page":"254-262","source":"Crossref","is-referenced-by-count":15,"title":["Predictive value of C\u2010reactive protein for tuberculosis, bloodstream infection or death among HIV\u2010infected individuals with chronic, non\u2010specific symptoms and negative sputum smear microscopy"],"prefix":"10.1111","volume":"23","author":[{"given":"Richard A.","family":"Bedell","sequence":"first","affiliation":[{"name":"Dignitas International Zomba Malawi"},{"name":"Division of Global Health University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique","family":"van 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