CRP Testing Research Articles

In primary care, CRP testing reduced antibiotic use in COPD exacerbations without worsening health.

Source Citation Butler CC, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med. 2019;381:111-20. 31291514

Can Point-of-Care CRP testing identify children with serious infection?

As paediatric emergency clinicians, a large part of our job is identifying the child with a serious infection. The utility of blood tests in helping with diagnosis in this group of children is debatable. Could point-of-care CRP testing help identify children with serious infection? Verkabel JY, Lemiengre MB, De Burghgraeve T, et al. Point-of-care C… Read More »Can Point-of-Care CRP testing identify children with serious infection?

Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions.

Antibiotics are overprescribed for non-severe acute infections in children in primary care. To explore two different interventions that may reduce inappropriate antibiotic prescribing for non-severe acute infections. A cluster randomised, factorial controlled trial in primary care, in Flanders, Belgium. Family physicians (FPs) enrolled children with non-severe acute infections into this study. The participants were allocated to one of four intervention groups according to whether the FPs performed: (1) a point-of-care C-reactive protein test (POC CRP); (2) a brief intervention to elicit parental concern combined with safety net advice (BISNA); (3) both POC CRP and BISNA; or (4) usual care (UC). Guidance on the interpretation of CRP was not provided. The main outcome was the immediate antibiotic prescribing rate. A mixed logistic regression was performed to analyse the data. In this study 2227 non-severe acute infections in children were registered by 131 FPs. In comparison with UC, POC CRP did not influence antibiotic prescribing, (adjusted odds ratio [AOR] 1.01, 95% confidence interval [CI] = 0.57 to 1.79). BISNA increased antibiotic prescribing (AOR 2.04, 95% CI = 1.19 to 3.50). In combination with POC CRP, this increase disappeared. Systematic POC CRP testing without guidance is not an effective strategy to reduce antibiotic prescribing for non-severe acute infections in children in primary care. Eliciting parental concern and providing a safety net without POC CRP testing conversely increased antibiotic prescribing. FPs possibly need more training in handling parental concern without inappropriately prescribing antibiotics.

Review: In primary care, CRP testing, shared decision making, and procalcitonin reduce antibiotic prescribing for ARI.

Source Citation Tonkin-Crine SK, Tan PS, van Hecke O, et al. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an over...

IMPACT OF POINT OF CARE CRP TESTING ON THE MANAGEMENT OF PATIENTS WITH SUSPECTED COMMUNITY ACQUIRED PNEUMONIA IN THE ED

Objectives & BackgroundThe World Health Organisation has identified antimicrobial resistance as “an increasingly serious threat to global public health that requires action across all government sectors and society”, and state...

Point-of-care CRP testing in the diagnosis of pneumonia in adults

Respiratory tract infections (RTI) are among the most common acute conditions leading to GP consultations and to antibiotic prescribing in primary care, even though 70% are viral, and many others...

CRP testing could reduce antibiotic prescribing

A consensus report sets out how point‐of‐care C‐reactive protein testing could reduce antibiotic prescribing for lower respiratory tract infections with no impact on patients.

Predictors of treatment with antibiotics and systemic corticosteroids for acute exacerbations of asthma and chronic obstructive pulmonary disease in primary care.

BackgroundAntibiotic and oral corticosteroid prescribing rate in patients suffering from acute exacerbations of chronic obstructive pulmonary disease (COPD) or asthma in general practice are only sparsely described. Our aim was to identify predictors for such prescribing when results from CRP testing, spirometry, and pulse oximetry are available.MethodsPatients aged 40 years or more diagnosed with asthma, COPD or both, the previous five years from seven general practice offices in Norway, were invited to a baseline examination and asked to visit their GPs during exacerbations the following 12 months. At all visits, symptoms, chest findings, and results from spirometry, pulse oximetry and CRP testing were registered.ResultsOut of the 376 who took part in baseline examination, 95 patients with an exacerbation were included in the analysis. Based on the diagnosis made by GPs, 46 patients (48.4%) were only registered with asthma, and 49 (51.6%) with COPD (or both diagnosis). 11 patients had taken antibiotics and 16 had taken systemic corticosteroids prior to their visit to their GPs. After excluding those already treated, antibiotics were prescribed in 34.9% and systemic corticosteroids in 42.5% of patients diagnosed with COPD compared to 14.6% and 30.8% respectively in patients only diagnosed with asthma (P = 0.02, P = 0.2). In the COPD group, antibiotic prescribing was not significantly associated with purulence or other respiratory symptoms, but increased phlegm was a significant predictor of antibiotic prescribing in the whole sample (P = 0.04). Prolonged expiration, wheezes and diminished breath sounds also predicted the prescribing of both antibiotics and systemic corticosteroids in the whole sample with P values < 0.01. The prescribing rate of antibiotics and systemic corticosteroids also increased with increasing CRP value (P = 0.001 and P = 0.01, respectively) and with decreasing oxygen saturation (P = 0.01 and P = 0.003, respectively). FEV1/FVC < 0.7 at baseline was as significant predictor in patients with COPD and in the whole sample of patients regarding treatment with antibiotics (P = 0.004 and P = 0.001, respectively) and treatment with systemic corticosteroids (P = 0.004 and P = 0.001, respectively).ConclusionChest findings, raised CRP value and decreased oxygen saturation were stronger predictors of prescribing of antibiotics and systemic corticosteroids than were respiratory symptoms. Further evaluation of the importance of these findings to guide treatment of asthma and COPD exacerbations is warranted.

CRP testing in RTI: better outcomes at lower cost

CRP testing in RTI: better outcomes at lower cost

Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies

Most patients with respiratory tract infections (RTIs) are prescribed antibiotics in general practice. However, there is little evidence that antibiotics bring any value to the treatment of most RTIs. Point-of-care C-reactive protein testing may reduce antibiotic prescribing. To systematically review studies that have examined the association between point-of-care (POC) C-reactive protein testing and antibiotic prescribing for RTIs in general practice. Systematic review and meta-analysis of randomised controlled trials and observational studies. MEDLINE(®) and Embase were systematically searched to identify relevant publications. All studies that examined the association between POC C-reactive protein testing and antibiotic prescribing for patients with RTIs were included. Two authors independently screened the search results and extracted data from eligible studies. Dichotomous measures of outcomes were combined using risk ratios (RRs) with 95% confidence intervals (CIs) either by fixed or random-effect models. Thirteen studies containing 10 005 patients met the inclusion criteria. POC C-reactive protein testing was associated with a significant reduction in antibiotic prescribing at the index consultation (RR 0.75, 95% CI = 0.67 to 0.83), but was not associated with antibiotic prescribing at any time during the 28-day follow-up period (RR 0.85, 95% CI = 0.70 to 1.01) or with patient satisfaction (RR 1.07, 95% CI = 0.98 to 1.17). POC C-reactive protein testing significantly reduced antibiotic prescribing at the index consultation for patients with RTIs. Further studies are needed to analyse the confounders that lead to the heterogeneity.

Value of serum procalcitonin levels in predicting spontaneous bacterial peritonitis.

Spontaneous bacterial peritonitis (SBP) is a life-threatening disease that poses a great diagnostic challenge to clinicians. We aimed to systemically and quantitatively summarize the current evidence on the diagnostic value of the procalcitonin (PCT) test in identifying SBP. We searched EMBASE, MEDLINE, the Cochrane database and reference lists of relevant articles with no language restrictions through May 2012. We selected original research that reported the diagnostic performance of PCT alone or compared with other biomarkers to diagnose SBP. We summarized test performance characteristics using forest plots, summary receiver operating characteristic curves and bivariate random effects models. We found only three qualifying studies examining 181 episodes of suspected infection with 50 (27.6%) confirmed SBP episodes from 3 countries. Bivariate pooled sensitivity, specificity, positive likelihood ratios and negative likelihood ratios were 86% (95%CI: 73%-94%), 80% (95%CI: 72%-87%), 7.73 (95%CI: 0.91-65.64) and 0.14 (95%CI: 0.01-1.89), respectively. The global measures of accuracy, area under the receiver operating curve (AUROC) and diagnostic odds ratio (DOR), showed PCT has excellent discriminative capability and individual study showed serum PCT testing has better accuracy than ascitic PCT, serum CRP or IL-6 testing. There was evidence of significant heterogeneity but no evidence of publication bias. The existing literature suggests moderate to high accuracy for PCT as a diagnostic aid for SBP. However, larger, appropriately designed prospective studies are needed to conclusively address the value of serum PCT testing in SBP diagnosis.

826 Bedside C-Reactive Protein Testing in Febrile Children Reduces Length of Stay at the Emergency Department

Background and AimsC-Reactive Protein (CRP) is an important diagnostic marker in the evaluation of febrile children. Aim is to study if bedside CRP testing reduces the length of stay (LOS)...

Intervention to reduce C-reactive protein determination requests for acute infections at an emergency department

IntroductionC-reactive protein (CRP) levels rise during inflammatory processes and have been ordered for rheumatic disease follow-up since the 1950s. The number of tests ordered in the emergency setting has increased,...

A pilot study of the use of near-patient C-Reactive Protein testing in the treatment of adult respiratory tract infections in one Irish general practice

BackgroundNew approaches are being sought to safely reduce community antibiotic prescribing. A recent study demonstrated that CRP testing resulted in decreased antibiotic prescribing for lower respiratory tract infection in primary care. There is little other published primary care data available evaluating CRP in the treatment of lower respiratory tract infections in routine clinical practice. This pilot study aims to describe the performance of near-patient CRP testing, in a mixed payments health system. Specific areas to be reviewed included the integrity of the study protocol, testing of data collection forma and acceptability of the intervention.PatientsPatients over the age of 18 years, with acute cough and/or sore throat with a duration of one month or less, in routine clinical practice.MethodDesign: A pilot with a cross-sectional design. The first 60 recruited patients were treated with routine clinical management, and GP's had no access to a CRP test. For the subsequent 60 patients, access to CRP testing was available.Participants: 3 GP's in one Irish primary care practice recruited 120 patients, fulfilling the above criteria over five months, from January 1 to May 31, 2010.Main outcome measures: The primary outcome was antibiotic prescription at the index consultation. Secondary outcomes were the numbers of delayed prescriptions issued, patient satisfaction immediately after consultation and re-consultations and antibiotic prescriptions during 28 days follow-up.ResultsThe protocol and data collection forms worked well and the intervention of CRP testing appeared acceptable. Thirty-five (58%) patients in the no-test group received antibiotic prescriptions compared to 27 (45%) in the test group. Both groups demonstrated similarly high level of patient satisfaction (85%). Fourteen (23%) patients in the CRP test group re-attended within 28 days compared to 9 (15%) in the no-CRP test group.ConclusionThis pilot study confirms the potential feasibility of a full trial in Irish general practice. Further consideration of possible increased re-attendance rates in a mixed payments health system is appropriate. We intend to pursue a larger trial in a newly established regional primary care research network.

Laparoscopic and open cholecystectomy in patients with acute cholecystitis the impact of gastrointestinal function and CRP

Objective To evaluate laparoscopic and open cholecystectomy for acute cholecystitis after the impact of gastrointestinal function and CRP. Methods 80 cases of acute cholecystitis and cholecystectomy were randomly divided into two groups. The laparoscopic group:40 underwent laparoscopic cholecystectomy.Laparotomy group:open cholecystectomy. Two groups of patients for evaluation of gastrointestinal function and CRP testing, were analyzed. Results Acute cholecystitis evaluation of gastrointestinal function. Laparoscopic group of 40 patients, Ⅰ grade 8 cases accounted for 20.0% , Ⅱ grade 15 cases accounted for 37.5% , Ⅲ grade 17 cases accounted for 42. 5%. Laparotomy group of 40 patients, Ⅰ 5 cases accounted for 12.5% , Ⅱ , 13 cases accounted for 32.5%, Ⅲ grade 22 cases accounted for 55.0%. Postoperative acute cholecystitis CRP test rating:laparoscopic group of 40 patients, normal in 6 cases accounted for 15.0% , slightly increased in 11 cases accounted for 27.5% , 40. 0% moderately elevated in 16 cases, severe increase of 7 cases 17.5%. Open group, 40 patients, normal in 2 cases(5.0%) , slightly increased in 13 cases (32. 5%), 35.0% moderately elevated in 14 cases, 11 cases of severe increased 27.5%. Conclusion The laparoscopic operation time was significantly lower than open surgery, avoiding the abdominal organs after abdominal exposure is conducive to rapid postoperative recovery of gastrointestinal function. Laparoscopy post-traumatic immune response than open surgery light. Key words: Acute cholecystitis; Laparoscopic cholecystectomy; Open cholecystectomy; Gastrointestinal function; CRP

Eligibility for Statin Therapy by the JUPITER Trial Criteria and Subsequent Mortality

Conclusion: Applying JUPITER trial eligibility criteria, 21% of patients not eligible for lipid-lowering therapy by the guidelines proposed by the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) would be eligible for lipid-lowering therapy based on JUPITER trial eligibility. Summary: The JUPITER trial reported that individuals without diabetes who were not eligible for lipid-lowering therapy by traditional guidelines, but who had C-reactive protein levels (CRP) ≥2.0 mg/L, had a 20% reduction in all cause mortality and a 44% reduction in vascular events with rosuvastatin treatment compared with placebo. Patients were eligible for JUPITER if they had a low-density lipoprotein cholesterol (LDL-C) level <130 mg/dL, no diabetes, no concurrent use of hormone replacement therapy, a creatinine <2 mg/dL, and triglycerides <500 mg/dL. The NCEP ATP (JAMA 2001;285:2486-97) has suggested strategies for primary prevention of coronary heart disease are appropriate in persons with high levels of LDL-C (>160 mg/dL) or those with borderline high LDL-C (130-159 mg/dL) and multiple (≥2) risk factors. Therefore, patients eligible for JUPITER, in many cases, would not be suggested for statin treatment by the ATP III guidelines. The authors therefore sought to evaluate the effect of applying JUPITER criteria vs those suggested by ATP III guidelines to the general population. The study group consisted of 3229 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. This is an observation study of white and African Americans aged ≥45 years. Fifty-six percent of the sample resides in the 10 southern “stroke belt” states, with the rest from the other 38 contiguous states. Among 11,339 participants age-eligible for JUPITER and without a vascular diagnosis or using lipid-lower therapy, 2342 (21%) met JUPITER criteria. Compared with participants in the JUPITER study, they had similar LDL-C and CRP levels, were more often women, black, and had metabolic syndrome. At 3.5 years of follow-up, the mortality rate in REGARDS participants eligible for JUPITER was 1.17 per 100 patient-years (95% CI, 0.94-1.42). Compared with those who were otherwise eligible for JUPITER who had CRP levels <2 mg/L (n = 2620), those with CRP levels ≥2 mg/L had an adjusted relative total mortality risk of 1.5 (95% CI, 1.1-2.2). Comment: The implication of the article is that CRP testing should be added to risk stratification of vascular disease and that many thousands of patients potentially benefiting from statin therapy are not being offered treatment. Almost half of REGARDS participants eligible for JUPITER on the basis of clinical factors before CRP testing were eligible on the basis of having CRP levels ≥2 mg/L. REGARDS participants eligible for JUPITER, who did not meet ATP III guidelines for lipid lowering but who had a CRP level ≥2 mg/L, had a 50% greater mortality than those with CRP levels <2 mg/L. The bottom line is that if JUPITER criteria are applied for application of lipid-lowering therapy, twice as many individuals would be eligible for lipid-lowering therapy compared with those eligible by ATP III guidelines.

Abstract A119: Effect of weight-bearing exercise on circulating biomarkers in breast cancer survivors

Abstract Breast cancer patients generally demonstrate a gain in body fat mass accompanied by loss of lean mass (i.e. muscle) during cancer therapy (Demark-Wahnefried et al, J. Clin Oncol, 2001). These changes may lead to adverse metabolic and inflammatory phenotypes. The objective of this pilot study was to evaluate changes in metabolic, inflammatory, and growth factor biomarkers among breast cancer survivors following 8 weeks of supervised resistance training combined with self-reported cardiovascular training. No diet or weight loss component was included in the intervention. Twenty-seven breast cancer survivors (78.3% Caucasian, mean age 56.5 ± 8.1 yrs, mean BMI 29.8 ± 4.4kg/m2) who were on average 5 years post-cancer treatment were recruited to participate in a prospective behavioral intervention trial to test the hypothesis that weight bearing activity including stretching, resistance, balance, and aerobic training would improve select metabolic and inflammatory indicators over an 8 week period. Height, weight, body composition (dual X-ray absorptiometry), fasting plasma glucose, insulin, IL-6, CRP, IL-1Ra, and IGF-1 were measured at baseline and 8 weeks. IL-6, IL-1Ra and IGF-1 were analyzed using high sensitivity ELISA and glucose was measured by a glucose oxidase-peroxide reaction; insulin and CRP testing were performed by the local hospital clinical laboratory. The homeostasis model of insulin resistance was computed (HOMA-IR) from glucose and insulin values. Eighty-one percent of the sample completed the 8-week intervention. Among completers (n=22) there was no significant change in body weight. Inflammatory response, as assessed using IL-1Ra, was improved (76.75 ± 161.39, p&amp;lt;0.05), however, there was no significant change in IL-6 or CRP. IGF-1 and HOMA-IR also remained unchanged. Breast cancer survivors participating in a pilot, short-term structured physical activity intervention targeting resistance training, in the absence of diet or weight change, demonstrated a significant improvement in the anti-inflammatory biomarker IL-1Ra without concomitant increases in pro-inflammatory biomarkers, IL-6 and CRP. Larger studies with sufficient sample size to detect statistically significant differences should be pursued; combining structured exercise with diet to support weight reduction may also be superior and should be evaluated. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A119.

'Experience talks': physician prioritisation of contrasting interventions to optimise management of acute cough in general practice

BackgroundUptake of interventions to improve quality of care by clinicians is variable and is influenced by clinicians' attitudes. The influence of clinicians' experience with an intervention on their preference for adopting interventions is largely unknown.MethodsThematic analysis of semi-structured interviews exploring views and attitudes towards an illness-focused intervention (specific communication skills training) and a disease-focused intervention (C-reactive protein, or CRP, point-of-care testing) to optimize management of lower respiratory tract infections (LRTI) among general practitioners (GPs) who had used both interventions for two years in a randomised trial (exposed GPs), and GPs without experience of either intervention (non-exposed GPs).ResultsAll but two of the ten non-exposed GPs indicated that they would prioritise implementation of the disease-focused intervention of CRP testing over communication skills training, while all but one GP in the exposed group said that they would prioritise the illness-focused approach of communication skills training as it was more widely applicable, whereas CRP testing was confirmatory and useful in a subgroups of patients.ConclusionThere are differences in attitudes to prioritising contrasting interventions for optimising LRTI management among GPs with and without experience of using the interventions, although GPs in both groups recognised the importance of both approaches to optimise management of acute cough. GPs' experiences with and attitudes towards interventions need to be taken into account when planning rollout of interventions aimed at changing clinical practice.

Evaluation of immunoturbidimetric specific protein methods using the Architect ci8200: comparison with immunonephelometry

Specific proteins have traditionally been analyzed using methodologies such as immunonephelometry on specialized analyzers. It is now possible to perform specific protein testing on clinical chemistry analyzers using immunoturbidimetry. Performance characteristics of turbidimetric assays for eight common specific proteins were evaluated against a nephelometric method. The Abbott Architect ci8200 and the Beckman Immage were used to perform IgA, IgG, IgM, C3, C4, haptoglobin, and transferrin testing. Abbott, Sentinel and Roche reagents were used to perform CRP testing on the ci8200. The specific protein assays were evaluated for precision, linearity, limit of detection, functional sensitivity, method comparison, prozone, and workflow. Total precision for the immunoturbidimetric assays was consistently better than 2% CV and linear throughout the dynamic range of the assays (recovery +/- 10% of target values). The limits of detection, functional sensitivities, and accuracy (as determined by performance against target values for proficiency testing samples and reference materials) are suitable for clinical purposes. Method comparison, as determined by correlation coefficients, and performance against proficiency testing samples, demonstrated good agreement between the turbidimetric and nephelometric tests. Both the turbidimetric and nephelometric assays provided reliable results under conditions of antigen excess. Specific protein test requests could be consolidated within our routine chemistry workload without impacting analytical test throughput. As demonstrated by their performance characteristics, the Architect ci8200 immunoturbidimetric specific protein assays are suitable for routine use and correlate well with representative immunonephelometric assays on the Beckman Immage analyzer. The ability to perform specific protein analyses on an integrated clinical chemistry/immunoassay system can allow for consolidation of testing on a single platform, resulting in improved laboratory operations efficiency.

Endocrine Aspects of Acute Illness

Respiratory tract infections (RTI) are among the most common acute conditions leading to GP consultations and to antibiotic prescribing in primary care, even though 70% are viral, and many others are minor self-limiting bacterial infections.^1-4 Between 0.5% and 1.1% of adults have community-acquired pneumonia every year in the UK, most of whom are managed in primary care.^4,5 The decision to prescribe antibiotics for an acute RTI in primary care is often based on clinical symptoms, which have low sensitivity and specificity, and high inter-observer variability.^2,4 In primary care, it is very difficult to differentiate between diagnoses without additional tests.⁶ Unnecessary antibiotic prescribing may not aid recovery, exposes patients to potential adverse effects, may encourage repeat attendance and contributes to antibiotic resistance.^2,7 One strategy aiming to reduce antibiotic prescribing in primary care is the use of biomarkers (e.g. C-reactive protein [CRP]).² In the correct clinical context (e.g. in previously healthy people, not those with chronic lung disease) and as an adjunct to clinical assessment, a biomarker may help in the management of an RTI.² In order to be used during the consultation, the results of a biomarker test must be rapidly available (e.g. ‘point-of-care’ [POC] testing).⁴ POC testing for CRP has recently been recommended as part of a national clinical guideline on the diagnosis and management of pneumonia.⁴ Here, we review the rationale for POC CRP testing and its advantages and disadvantages.