C-reactive Protein Test Results Research Articles

Association of C-Reactive Protein (CRP) Test Results with The Decision on Cytological Examination of Pleural Effusion Fluid

Background: Pleural effusion is an abnormal collection of fluid within the pleural lining resulting from a disturbance in the balance affecting the inflow and outflow from the area. Pleural fluid is associated with various medical diseases such as heart failure, pneumonia, and malignancy. Rapid and accurate diagnosis remains a major clinical challenge in patients with suspected pleural infection. As clinical data may be elusive, measurement of biomarkers in pleural fluid can estimate the likelihood of infection, and C-reactive protein (CRP) is the biomarker of choice for detecting inflammatory states.
 Method: The research method used in this study is descriptive research. This study was conducted at the anatomical pathology laboratory of Siloam Jambi Hospital in March - June 2023. The population in this study was 57 patients with pleural effusion. The samples in this study were all pleural effusion patients who performed Cytology and CRP examinations at Siloam Jambi Hospital from March-June 2023 at the Anatomical Pathology Laboratory Unit of Siloam Jambi Hospital.
 Result: The CRP test results in the group with cytology examination decision which were categorized in the inflammation group had an average of 6.6 ± 1.83 mg/L. CRP continued to increase in adenocarcinoma group (46 ± 19.03 mg/L) and metastatic carcinoma group (105.6 ± 48.68 mg/L). There was a very significant increase in the CRP test results along with an increase in the decision of the results of the pleural fluid cytology examination (p-value <0.01).
 Conclusion: CRP test results show potential in predicting cytology examination decisions in patients with pleural effusion.

Correlation of C-Reactive Protein and Erythrocyte Sedimentation Rate in Covid-19 Cases

In December 2019, a mysterious pneumonia case was first reported in Wuhan, Hubei Province known as COVID-19, and its etiologic agent, SARS-Cov-2 virus. C-Reactive Protein (CRP) is a homopentameric protein that appears in inflammatory conditions. Erythrocyte sedimentation rate (ESR) increases in both acute and chronic inflammations. This study aimed to determine the correlation between CRP and ESR concentrations with the status of PCR diagnostic test results in patients. It was a correlation study with a cross-sectional approach. The data was taken from results from the first PCR and laboratory examination of the patients for COVID-19. The population of this study was patients under monitoring (PDP) for COVID-19 who were treated at a hospital in East Bekasi, West Java. The sample for this study was 65 people, consisting of 28 (43.1%) negative COVID-19 patients and 37 (56.9%) positive COVID-19 patients. The results showed that at the start of the PCR test for COVID-19, there was a weakly significant increase in CRP (r=0.311), and there was a significant relationship between the COVID-19 PCR results and the patient's CRP levels (p=0.040) in the age group 1-40 years. In addition, there was an increase in the respiratory rate in patients with high CRP with a weak significance (r=0.366), and a significant relationship between the CRP test results and the patients’ respiratory rate (p=0.026). In addition, there was a strong relationship between CRP increase and LED increase (p=0.000).

C-reactive protein point of care testing in community pharmacy: Observational study of a Northern Ireland pilot.

Whether or not to prescribe an antibiotic is a key issue for clinicians treating respiratory tract infection (RTI) in the community. Measurement of C-reactive protein (CRP) in community pharmacy may help to differentiate viral and self-limiting infections from more serious bacterial infections. To pilot POC CRP testing for suspected RTI within community pharmacy in Northern Ireland (NI). POC CRP testing was piloted in 17 community pharmacies linked to 9 general practitioner (GP) practices in NI. The service was available to adults presenting to their community pharmacy with signs and symptoms of RTI. The pilot (between October 2019 and March 2020) was stopped early due to Coronavirus-19 (COVID-19). During the pilot period, 328 patients from 9 GP practices completed a consultation. The majority (60%) were referred to the pharmacy from their GP and presented with <3 symptoms (55%) which had a duration of up to 1 week (36%). Most patients (72%) had a CRP result of <20mg/L. A larger proportion of patients with a CRP test result between 20mg/L and 100mg/L and >100mg/L, were referred to the GP when compared to patients with a CRP test result of <20mg/L. Antimicrobial prescribing rates were studied in a subgroup (n=30) from 1 practice. Whilst the majority (22/30; 73%) had a CRP test result of <20mg/L, 50%, (15/30) of patients had contact with the GP in relation to their acute cough and 43% (13/30) had an antibiotic prescribed within 5 days. The stakeholder and patient survey reported positive experiences. This pilot was successful in introducing POC CRP testing in keeping with National Institute of Health and Care Excellence (NICE) recommendations for the assessment of non-pneumonic lower RTIs and both stakeholders and patients reported positive experiences. A larger proportion of patients with a possible or likely bacterial infection as measured by CRP were referred to the GP, compared to patients with a normal CRP test result. Although stopped early due to COVID-19, the outcomes provide an insight and learning for the implementation, scale up and optimization of POC CRP testing in community pharmacy in NI.

The effects of add-on therapy of Phyllanthus Emblica (Amla) on laboratory confirmed COVID-19 Cases: A randomized, double-blind, controlled trial

ObjectiveThis randomized, double-blind, controlled trial (RCT) aimed to evaluate the effect of Phyllanthus Emblica (Amla) as an add-on therapy on COVID-19_ related biomarkers and clinical outcomes in COVID-19 patients. MethodsIn this RCT, sixty-one patients were randomly assigned into two arms [the intervention (n=31) and control arms (n=30)]. The effect of Amla on diagnostic Reverse-transcription Polymerase Chain Reaction (RT-PCR) test results between the first and the last days of the study, the length of stay (LOS) in hospital, the percentage of lung involvement on CT scans, changes in the clinical symptoms, and the laboratory markers were assessed. ResultsThe two study groups had similar baseline demographics and characteristics in terms of medical history. The mean of LOS in the intervention arm (4.44 days) was significantly shorter than in the control arm (7.18 days, P < 0.001); RT-PCR results were not significantly different between the two arms (P = 0.07). All clinical variables decreased over time in the two groups (P < 0.001). However, the difference between the two groups in terms of fever (P = 0.004), severity of cough (P = 0.001), shortness of breath (P = 0.004), and myalgia (P = 0.005) were significant, but this intergroup comparison was not significant with regard to respiratory rate (P = 0.29), severity of chills (P = 0.06), sore throat (P = 0.22), and weakness (P = 0.12). Out of the eight evaluated para-clinical variables, three variables showed significant improvement in the intervention arm, including the mean increase in oxygen saturation (SpO2) level (P < 0.001), the reduction in the mean percentage of lung involvement on CT (P < 0.001), and the improvement in C-reactive protein test results (P < 0.001). ConclusionOrganic herbal Amla tea cannot significantly affect the RT-PCR results and or degree of lung involvement. Nevertheless, it showed an ameliorative effect on the severity of clinical signs and CRP levels. Also, Amla tea may shorten the recovery times of symptoms and LOS in COVID-19 patients.

Raised inflammatory markers as a predictor of one-year mortality: a cohort study in primary care in the UK using electronic health record data

ObjectivesIdentification of patients at increased mortality risk is important in the context of increasing multimorbidity and an ageing population, to help facilitate the planning and delivery of services. The aim...

Low or no CRP at the point of admission to a medical admissions unit is associated with a low rate of 48-hour antimicrobial review amongst patients prescribed antibiotics

Introduction: Antibiotic resistance is rising and multi-resistant organisms are readily being identified; therefore fear of mortality rates rising due to infection is becoming a genuine prospect. We sought to measure clinical review post antimicrobial prescription in two acute hospitals in Wales to establish whether review is undertaken at 48-hours and whether likelihood of clinical review taking place depends on C reactive protein (CRP) levels on admission. Methods: An audit across two hospitals in South Wales assessing compliance of antimicrobial review as recommended by NICE guidelines was undertaken over a three week period. In addition, univariate odds ratios for 48-hour referral stratified by CRP test results (excluding patients with no CRP test) were calculated in a logistic regression model using the high CRP group as the referent. Following initial results intervention (education and prompt stickers) were introduced to prompt 48-hour review. Results: 139 patients were included in the pre-intervention audit from both sites. 53% were reviewed at 48 hours. Initial interventions demonstrated an improvement in compliance in all CRP categories. In the logistic regression analysis setting the highest CRP group (CRP &lt;=100) as referent showed that the likelihood of a 48 hour review was lower in patients with lower CRP test results, or no CRP test than those with a CRP of &gt;=100. Conclusion: Patients with low or no CRP on admission are less likely to have their antimicrobial prescriptions reviewed when compared 48 hours. Intervention should continue to be sought to raise awareness of this.

Improve the consistency of C-reactive protein test results using trueness control material

Objective To explore the CRP harmonization by calibration using commutable trueness verification materials. Methods High and low level of CRP concentrations trueness verification materials(H and L) were prepared by Beijing center for clinical laboratories. Thesetrueness verification materials were diluted to 5 calibration points(5L, 4L+1H, 3L+2H, 1L+4H, 5H) by weighing method, respectively. These 5 points were used to calibrate four different brands of CRP detection system (Diasys, Leadman, Siemens and Roche) instead of the original procedure. Sera from 21 patients and the international standard ERM DA-474/IFCC were used to compare harmonization and trueness after calibration. Each sample above was measured twice. Results After calibration, the median of CV was reduced from 19.33% to 2.92% among 21 patient samples, less than the optimal CV based on biological variability (CV=10.6%). Compared with Desai, the slopes were closer to 1 from 0.90-1.09 to 0.93-0.96 after calibration. Meanwhile, if ERM-DA474/IFCC was used as the trueness verification materials, the absolute bias wasreduced from 3.08-11.07 mg/L to 0.52-2.97 mg/L which was close to theuncertainty of itself (2.5 mg/L). Conclusions Afterthe calibration which contained five linear concentration points of CRP trueness verification materials by weighing method, both harmonization and trueness of CRP were improved. Key words: C-reactive protein; Calibration; Reference standards; Reproducibility of results

C-reactive protein point-of-care testing and associated antibiotic prescribing

In clinical trials, the potential of point-of-care (POC) C-reactive protein (CRP) tests was demonstrated in decreasing antibiotic prescribing in adults with acute cough in general practice, but effects of implementation are unknown. To determine the overall effect of POC CRP testing on antibiotic prescribing rate in general practice. In an observational study, GPs were instructed to use POC CRP in adults with acute cough following current guidelines. After routine history taking and physical examination, they reported whether they intended to prescribe antibiotics ('pre-test decision'). They reported their revised decision after receiving the POC CRP test result ('post-test decision'). Primary outcome was the percentage of patients in whom the GP changed his or her decision to prescribe antibiotics. Secondary outcome was the difference between 'pre-test' and 'post-test' antibiotic prescribing % at group level. A total of 40 GPs enrolled 939 patients, 78% of whom were tested for CRP. GPs changed their decision after POC CRP testing in 200 patients (27%). Antibiotic prescribing before and after CRP testing did not differ ('pre-test' 31%, 'post-test' 28%; 95% confidence interval of difference -7 to 1). In 41% of the tested patients, the indication for testing was in accordance with the guidelines. POC CRP influenced GPs to change their decision about antibiotic prescribing in patients with acute cough. POC CRP testing does not reduce overall antibiotic prescribing by GPs who already have a low antibiotic prescribing rate.

Diagnostic accuracy and clinical role of rapid C-reactive protein testing in HIV-infected individuals with presumed tuberculosis in South Africa

To determine the accuracy and role of rapid C-reactive protein (CRP) testing in human immunodeficiency virus (HIV) infected individuals with presumed tuberculosis (TB). We enrolled HIV-infected adults (≥18 years)with a cough of ≥2 weeks and negative sputum smears for acid-fast bacilli in KwaZulu-Natal, South Africa. Participants were evaluated for pulmonary TB (PTB) by a nurse with rapid CRP, and independently by a physician by chest radiograph. Rapid CRP test results were compared with laboratory CRP and sputum sent for confirmation of TB. Among 93 participants, 55 (59%) were female, the mean age was 35 years, and the median CD4 count was 177/mm3. Forty-five (54%) participants were diagnosed with PTB. Diagnostic sensitivity and specificity were respectively 95% (95%CI 74–99) and 51%(95%CI 35–66) for rapid CRP >8 mg/l, 87% (95%CI 73–96) and 53% (95%CI 38–68) for nurse assessment, and 69% (95%CI 52–83) and 76% (95%CI 61–87) for physician examination. Combining a negative rapid CRP(≤8 mg/l) with nurse and physician assessments reduced the post-test probability of PTB from 22% to 6% and from 32% to 6%, respectively. Rapid CRP testing helped exclude PTB,and may be a valuable test in assisting nurses and physicians in TB-endemic regions.

The antibiotic prescription and redemption gap and opportunistic CRP point-of-care testing. A cross-sectional study in primary health care from Eastern Austria

The aim of this study was to analyse the frequency of C-reactive protein (CRP) rapid test use by general practitioners (GPs), the role of the test in the antibiotic treatment decisions and the efficacy of the test in a primary care setting, with special emphasis on the redemption rate of antibiotic prescriptions. For this cross-sectional study, GPs documented their CRP test use for 2.5 years. In addition, demographic and the antibiotic prescription and redemption data of the patients were documented. Three groups were clustered according to the three possible CRP test results (1: < 10 mg/l, 2: 10-30 mg/l, 3: > 30 mg/l); analyses were conducted by using descriptive statistical methods and tests. Thirty GPs documented 692 initial CRP tests. The antibiotic prescription rate was 9.2 % for the first, 71.7 % for the second and 98.7 % for the third group (p < 0.001). A difference between the patients of the three CRP groups according to the redemption rate of antibiotic prescriptions (30.8 vs. 62.7 vs. 64.0 %; p = 0.013) could be found, with the lowest rate in the first group. Overall, 16.3 % of the patients filled an antibiotic at a pharmacy that was not in accordance with the CRP test result documentation form. The CRP test results show an association with both the antibiotic prescribing and redemption behaviour. Noticeable was the antibiotic redemption behaviour of the patients: 36 % of patients with a CRP test result over 30 did not fill the antibiotic prescribed which is an important finding related to patients adherence and of special interest due to the fact that none of these patients had a hospital admission afterwards. On the contrary, nearly one-fifth of the patients who did not get an antibiotic in connection with the CRP test result finally filled an antibiotic prescription.

The Role and Clinical Significance of High-Sensitivity C-Reactive Protein in Cardiovascular Disease

The Role and Clinical Significance of High-Sensitivity C-Reactive Protein in Cardiovascular Disease

Highly sensitive immunoassay based on E. coli with autodisplayed Z-domain

The Z-domain of protein A has been known to bind specifically to the F c region of antibodies (IgGs). In this work, the Z-domain of protein A was expressed on the outer membrane of Escherichia coli by using “Autodisplay” technology as a fusion protein of autotransport domain. The E. coli with autodisplayed Z-domain was applied to the sandwich-type immunoassay as a solid-support of detection-antibodies against a target analyte. For the feasibility demonstration of the E. coli based immunoassay, C-reactive protein (CRP) assay was carried out by using E. coli with autodisplayed Z-domain. The limit of detection (LOD) and binding capacity of the E. coli based immunoassay were estimated to be far more sensitive than the conventional ELISA. Such a far higher sensitivity of E. coli based immunoassay than conventional ELISA was explained by the orientation control of immobilized antibodies and the mobility of E. coli in assay matrix. From the test results of 45 rheumatoid arthritis (RA) patients’ serum and 15 healthy samples, a cut-off value was established to have optimal sensitivity and selectivity values for RA. The CRP test result of each individual sample was compared with ELISA which is the reference method for RA diagnosis. From this work, the E. coli with Z-domain was proved to be feasible for the medical diagnosis based on sandwich-type immunoassay.

Negative C-reactive protein in children with bacterial infection.

To evaluate the practical value of initial C-reactive protein (CRP) in the diagnosis of bacterial infection in children. The subjects comprised 11 children, six boys and five girls, aged 3 months through to 3 years (median age 16 months), whose initial CRP levels were < 1.0 mg/dL despite bacterial infection. C-reactive protein was quantitated at the first medical examination by nephelometry. The diagnosis was urinary tract infection (n = 4), bacterial meningitis (n = 2), sepsis (n = 2), pneumonia (n = 2) and arthritis of the hip joint (n = 1). The CRP levels were significantly elevated during the course of infection, ranging from 7.6 to 28.5 mg/dL. The bacterial etiology was non-specific. Eight patients were examined within 12 h of onset, three exhibited negative CRP values despite the duration of the insult over 12 h. Six patients were tentatively diagnosed as having a bacterial infection, but the other five were not. Each patient was treated, leading to a favorable outcome without any serious complications. Low levels of CRP do not rule out the possibility of bacterial infection in children. The initial value of CRP may be negative, even in patients with severe bacterial infection or even after 12 h from onset. The data suggest that pediatricians should consistently be aware of the possibility of bacterial infection even if the initial CRP test result is negative and that serial CRP measurements appear to be practical.

Comparison of Acute-Phase Reactants in Pediatric Patients With Fever

We compared WBC count greater than or equal to 15,000/cu mm (high WBC count). Wintrobe ESR greater than or equal to 30 mm/hr (high ESR), temperature greater than or equal to 40 degrees C, and positive slide tests for C-reactive protein (CRP) at a serum dilution of 1:50 in febrile, ambulatory children. The CRP test was performed with and without heat inactivation of serum. An excellent correlation was found between noninactivated and inactivated CRP test results. Since the noninactivated CRP test can be done quickly, its results would be readily available in an outpatient setting. High ESR demonstrated the best balance of specificity and sensitivity for bacteremia, pneumonia, and other possible or proved bacterial illnesses. A positive CRP test was highly specific for these diagnoses but less sensitive than an ERS greater than or equal to 30 mm/hr. Three combinations of acute-phase reactants, high WBC count and/or high ESR, high ESR and/or positive CRP test, and high WBC count and/or high ESR and/or positive CRP test performed as well as high ESR alone. Each was less specific but more sensitive than high ESR for possible or proved bacterial illnesses. The evaluation of an ambulatory, febrile child with acute-phase reactants should include at least determination of ESR.