Abstract
BackgroundTo assess the utility of C-reactive protein (CRP) velocity to discriminate between patients with acute viral and bacterial infections who presented with relatively low CRP concentrations and were suspected of having a bacterial infection.MethodsWe analyzed a retrospective cohort of patients with acute infections who presented to the emergency department (ED) with a relatively low first CRP measurement (CRP1) ≤ 31.9 mg/L and received antibiotics shortly after. We then calculated C-reactive protein velocity (CRPv), milligram per liter per hour, for each patient based on CRP1 and the second CRP value (CRP2) measured within the first 24 h since admission. Finally, we compared CRPv between patients with bacterial and viral infections.ResultsWe have presently analyzed 74 patients with acute bacterial infections and 62 patients with acute viral infections at the mean age of 80 and 66 years respectively, 68 male and 68 female. CRP1 did not differ between both groups of patients (16.2 ± 8.6 and 14.8 ± 8.5 for patients with viral and bacterial infections respectively, p value = 0.336). However, the CRP2 was significantly different between the groups (30.2 ± 21.9 and 75.6 ± 51.3 for patients with viral and bacterial infections respectively, p-value < 0.001) and especially the CRPv was much higher in patients with acute bacterial infections compared to patients with acute viral infections (0.9 ± 1.2 and 4.4 ± 2.7 respectively, p-value < 0.001).ConclusionCRPv and CRP2 are useful biomarkers that can discriminate significantly between patients who present with acute bacterial and viral infections, and relatively low CRP concentration upon admission who were suspected of having a bacterial infection.
Highlights
To assess the utility of C-reactive protein (CRP) velocity to discriminate between patients with acute viral and bacterial infections who presented with relatively low CRP concentrations and were suspected of having a bacterial infection
We proposed investigating our assumption by looking at patients with viral and bacterial infections who presented with relatively low first CRP measurement (CRP1) and received antibiotics soon after
The Estimated CRP velocity (eCRPv) was greater in patients with bacterial infections compared to patients with viral infections (1.2 ± 1.1 and 0.8 ± 1.6 respectively, p-value < 0.001, area under the curve (AUC) 0.7, CI 0.62–0.77)
Summary
To assess the utility of C-reactive protein (CRP) velocity to discriminate between patients with acute viral and bacterial infections who presented with relatively low CRP concentrations and were suspected of having a bacterial infection. The exact cut-off is still disputable and many different CRP values were suggested to indicate a bacterial infection (such as 10, 20, 40, 60 and 100 mg/L) [1, 4,5,6,7] This highlights the difficulty for physicians in using CRP for the diagnosis of patients with bacterial infections presenting with relatively low CRP concentrations. Previous studies showed that patients who presented with relatively low CRP values constitute a substantial fraction of the admissions to the emergency department (ED) with acute infectious disease and have a high potential to deteriorate quickly. Feigin et al suggested that presentation to the internal medicine department with a very low concentration of CRP (< 0.05) does not exclude the existence of significant acute morbidities [10] These studies emphasize the importance of early diagnosis in acutely ill patients presenting with relatively low CRP values
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
