What question did this study set out to answer?

This study aims to evaluate the diagnostic accuracy of a two-marker biosignature combining CRP and myeloperoxidase for symptomatic tuberculosis.

July 14, 2026Scientific Reports0 citationsOpen Access

Diagnostic accuracy of CRP and myeloperoxidase as a 2-marker biosignature for the diagnosis of symptomatic TB

LRLesego RanthoSouth African Medical Research Council BCBih H. ChendiSouth African Medical Research Council MBMegan-Lee BurgerSouth African Medical Research Council

Key Points

This study aims to evaluate the diagnostic accuracy of a two-marker biosignature combining CRP and myeloperoxidase for symptomatic tuberculosis.
Measured CRP and MPO levels in 109 serum samples from adults with TB-like symptoms.
Conducted ROC curve analysis to assess the diagnostic accuracy of the biomarkers.
Determined sensitivity and specificity for CRP and MPO individually and in combination.
CRP achieved an AUC of 0.90 and MPO an AUC of 0.66 for TB diagnosis.
Combined measurement yielded a sensitivity of 91.3% and specificity of 77.8% after cross-validation.
MPO increased CRP sensitivity by 2.2%, but the findings were not robust enough for strong validation.

Abstract

Non-sputum-based tests are urgently needed for rapid tuberculosis (TB) diagnosis. While the World Health Organization (WHO) recommends C-reactive protein (CRP) in serum as a TB screening tool for people living with HIV, it falls short of meeting the minimum target product profile (TPP) criteria for a triage test. We hypothesized that combining CRP with Myeloperoxidase (MPO) as a two-protein signature, would diagnose TB with improved accuracy. Using the Meso Scale Discovery platform, we measured CRP and MPO levels in 109 serum samples from adults presenting with TB-like symptoms at primary healthcare centres in South Africa, Uganda, and The Gambia. Diagnoses were based on clinical, laboratory, and radiological findings. Receiver Operator Characteristic (ROC) curve analysis assessed the biomarkers’ diagnostic accuracy. CRP and MPO levels differed significantly between TB and other respiratory diseases (ORD). Individually, CRP and MPO achieved areas under the ROC curve (AUCs) of 0.90 and 0.66, respectively. Combined, the AUC remained 0.90, but sensitivity and specificity improved to 91.3% and 77.8% after leave-one-out cross-validation. MPO only increased CRP sensitivity by 2.2%. Concurrent measurement of MPO may improve the accuracy of CRP when used together as a TB diagnostic signature. However, the evidence from our study was not strong and our preliminary findings require validation in larger studies.

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