Role of C-Reactive Protein and Erythrocyte Sedimentation Rate in the Diagnosis and Monitoring of Treatment Response in Treatment Naive Subjects with Chronic Pulmonary Aspergillosis

PurposeThe role of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for diagnosing chronic pulmonary aspergillosis (CPA) remains unknown. Herein, we investigate the diagnostic performance of serum ESR and CRP in CPA.MethodsWe retrospectively analyzed the data of treatment-naive subjects with CPA and diseased controls (post-tuberculosis lung disease on CT thorax). We treated CPA subjects with six months of oral itraconazole. Our primary objective was to evaluate the sensitivity and specificity of ESR and CRP in diagnosing CPA. The key secondary objective was to study the change in the inflammatory markers with treatment.ResultsWe included 434 subjects and 20 diseased controls. The sensitivity and specificity of ESR (n = 434) and CRP (at cut-off value of 10 mg/L, n = 308) in diagnosing CPA were 42.9% and 65%, and 52.3% and 65%, respectively. Both ESR and CRP had erratic trend following treatment. ESR and CRP declined or remained stable in approximately 60% of subjects but increased in approximately 40% of the subjects despite treatment.ConclusionSerum CRP and ESR have limited utility in diagnosing and following subjects with CPA.

Automated summary

This study investigates the diagnostic performance of serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in chronic pulmonary aspergillosis (CPA). The results show that both ESR and CRP have limited sensitivity and specificity in diagnosing CPA, and their trends also vary following treatment.