C-reactive Protein Cut-off Value Research Articles

The Diagnostic Value of Coagulation Indicators and Inflammatory Markers in Distinguishing Between Strangulated and Simple Intestinal Obstruction.

Background:Intestinal obstruction with strangulation can be life-threating, and it is critical to make an accurate and timely diagnosis for emergency surgery.Objective:This was aimed to investigate the value of coagulation indicators and inflammatory markers in distinguishing between strangulated and simple intestinal obstruction.Materials and Methods:Fifty-four patients with intestinal obstruction were retrospectively studied. The correlation between coagulation indicators and inflammatory markers with intestinal obstruction was analyzed. Receiver operating characteristic curves were created to assess their ability in discriminative diagnosis.Results:Levels of fibrinogen (Fib), C-reactive protein (CRP), neutrophil ratio, and D-Dimer were significantly greater, while thrombin time was significantly shorter in strangulated intestinal obstruction compared with simple intestinal obstruction. Furthermore, Fib levels in the necrosis subgroup of strangulated intestinal obstruction were significantly higher than those in the ischemia subgroup and simple intestinal obstruction group. The areas under the receiver operating characteristic curve were 0.58 for white blood cells, 0.78 for CRP, and 0.80 for Fib. Using the optimal cutoff values of Fib (3.71 g/L) and CRP (14.54 mg/L), the sensitivity, specificity, positive predictive value, and negative predictive value in discriminating between strangulated intestinal obstruction and simple intestinal obstruction were 51.43%, 100%, 100%, and 52.78% for Fib, and 56.25%, 94.44%, 94.74%, and 54.84% for CRP, respectively.Conclusions:Fib and CRP demonstrate good performance in predicting strangulation and are indicative of intestinal necrosis and ischemia. The combination of this coagulation indicator and inflammatory marker holds potential for better discrimination between strangulated and simple intestinal obstruction.

#54: Sensitivity and Specificity of Procalcitonin vs C Reactive Protein in Identifying Pediatric Bacterial infections

Abstract Background Procalcitonin (PCT) and c-reactive protein (CRP) have been utilized in children to assess risk for serious bacterial infections. However, there have been different cut-offs reported for PCT and CRP, which yield different sensitivity and specificity. This study aims to compare the sensitivity and specificity of PCT and CRP in detecting serious bacterial infections (SBIs), specifically urinary tract infections, bacteremia and meningitis. Methods In this retrospective, single center cohort study from January 2018 to June 2019, we analyzed children with a fever greater than 38C with both PCT and CRP value within 24 hours of admission. Each patient had a blood, urine and/or cerebrospinal fluid culture collected within 48 hours of admission. No antibiotics were administered from the admitting hospital prior to collection of the PCT or CRP. Our gold standard was a positive culture obtained from blood, cerebrospinal fluid, or urine. The statistical analysis included categorical variables as percentages and compared them using the Fisher exact test. The optimal cutoff values for PCT or CRP were based on ROC curve analysis and Youden Index. Sensitivity and specificity analysis were based on literature review cut offs and ROC curves cut offs. Results Among 202 children, we had 45 culture positive patients (11 urinary tract infections, 4 meningitis, and 32 bacteremia). The patients with culture positivity had higher PCT levels (7.9 ng/mL vs 2.5 ng/mL, P=0.0111), CRP levels (110.9 mg/L vs 49.6 mg/L, P<0.0001) and temperature (39.2C vs 39C, P<0.0052). The area under the curve (AUC) comparing culture positivity vs negativity for all culture types was 0.72 (p<0.0001) for PCT and 0.66 (p=0.001) for CRP. In Figure 1, the AUC for culture positive bacteremia was 0.68 (p=0.0011) for PCT and 0.70 (p=0.0003). The AUC for culture positive urinary tract infections (UTI) only was 0.86 (p=0.0001) for PCT and 0.70 (p=0.3607). For the cut-off value for PCT at 0.5 ng/mL, the sensitivity and specificity was 64% (95% confidence interval [CI] 0.5–0.77) and 70% (95% CI 0.62–0.77) respectively in identifying children with bacterial infection. For the cut-off value for CRP at 20 mg/L, the sensitivity and specificity was 67% (95% CI 0.52–0.79) and 52% (95% CI 0.44–0.59) respectively in identifying children with bacterial infection. Conclusion In this study, PCT and CRP are nearly equivalent classifiers for detecting SBIs as a group and bacteremia, but PCT is statistically better for urinary tract infections; however, the clinical utility is unknown.

C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

PurposeCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has spread around the world. Differentiation between pure viral COVID-19 pneumonia and secondary infection can be challenging. In patients with elevated C-reactive protein (CRP) on admission physicians often decide to prescribe antibiotic therapy. However, overuse of anti-infective therapy in the pandemic should be avoided to prevent increasing antimicrobial resistance. Procalcitonin (PCT) and CRP have proven useful in other lower respiratory tract infections and might help to differentiate between pure viral or secondary infection.MethodsWe performed a retrospective study of patients admitted with COVID-19 between 6th March and 30th October 2020. Patient background, clinical course, laboratory findings with focus on PCT and CRP levels and microbiology results were evaluated. Patients with and without secondary bacterial infection in relation to PCT and CRP were compared. Using receiver operating characteristic (ROC) analysis, the best discriminating cut-off value of PCT and CRP with the corresponding sensitivity and specificity was calculated.ResultsOut of 99 inpatients (52 ICU, 47 Non-ICU) with COVID-19, 32 (32%) presented with secondary bacterial infection during hospitalization. Patients with secondary bacterial infection had higher PCT (0.4 versus 0.1 ng/mL; p = 0.016) and CRP (131 versus 73 mg/L; p = 0.001) levels at admission and during the hospital stay (2.9 versus 0.1 ng/mL; p < 0.001 resp. 293 versus 94 mg/L; p < 0.001). The majority of patients on general ward had no secondary bacterial infection (93%). More than half of patients admitted to the ICU developed secondary bacterial infection (56%). ROC analysis of highest PCT resp. CRP and secondary infection yielded AUCs of 0.88 (p < 0.001) resp. 0.86 (p < 0.001) for the entire cohort. With a PCT cut-off value at 0.55 ng/mL, the sensitivity was 91% with a specificity of 81%; a CRP cut-off value at 172 mg/L yielded a sensitivity of 81% with a specificity of 76%.ConclusionPCT and CRP measurement on admission and during the course of the disease in patients with COVID-19 may be helpful in identifying secondary bacterial infections and guiding the use of antibiotic therapy.

C-reactive protein adjusted for body mass index as a predictor of postoperative complications following laparoscopic gastrectomy for gastric cancer.

This study aimed to clarify the relationship between obesity and postoperative C-reactive protein (CRP) and assess the usefulness of obesity status-adjusted CRP levels for predicting early complications following laparoscopic gastrectomy for gastric cancer. This study retrospectively analyzed 527 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2013 and March 2019. Patients were classified into three groups according to body mass index (BMI): BMI < 20; BMI ≥ 20 to < 25; and BMI ≥ 25. The correlation between BMI and perioperative CRP was investigated in 447 patients, excluding 80 with postoperative complications. The optimal CRP cutoff value of Clavien-Dindo (CD) grade ≥ 3 for predicting severe complications for each group was determined. BMI was significantly correlated with CRP on postoperative day (POD) 3 (p < 0.001) in 447 patients without complications. According to the receiver operating characteristic curve analysis, CRP cutoff values on POD 3 for predicting severe complications were 92.4, 111.1, and 171.9 in the BMI < 20, BMI ≥ 20 to < 25, and BMI ≥ 25 groups, respectively. In multivariate analysis for CD grade ≥ 3 complications, cardiac history and POD 3 CRP levels higher than the adjusted cutoff were identified as independent factors significantly associated with severe complications (p = 0.021 and 0.015, respectively). CRP cutoff values on POD 3 adjusted for BMI were useful for predicting severe complications in gastrectomy for gastric cancer.

Platelet-to-lymphocyte ratio and C-reactive protein as markers for colorectal polyp histological type

BackgroundThe platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP) level are markers that have been reported to predict the histological type of various tumors, and here, we evaluated their utility in predicting colorectal polyp histological types.MethodsWe retrospectively reviewed 172 patients with colorectal polyps who underwent endoscopic polypectomy. The associations between histological type and clinicopathologic parameters were assessed by multivariate analysis.ResultsThe optimal PLR and CRP cut-off values were 113.32 and 0.39, respectively. The PLR (P = 0.002) and CRP (P = 0.009) values were associated with the histological type according to the univariate analysis, whereas low PLR (P ≤ 0.001) and CRP (P = 0.017) values were independent risk factors in the multivariate analysis together with maximum tumor diameter (P ≤ 0.001) and tumor number (P = 0.0014).ConclusionsPreoperative PLR and CRP are correlated with the colorectal polyp histological type.

Value of the synovial C-reactive protein test in the diagnosis of total hip and knee periprosthetic joint infections: A case-control study

IntroductionThe diagnosis of periprosthetic joint infection (PJI) can be challenging and rests on several principles. The use of diagnostic biomarkers, such as the synovial C-Reactive Protein (CRP), seems promising. The purpose of this study was to determine whether synovial CRP was a more discriminating test than serum CRP for the diagnosis of hip and knee PJI. Materials and methodsIn total, 194 patients were included in this single center prospective study: 42 primary arthroplasties (control group [CG]), 111 revisions for aseptic prosthesis (aseptic revision group [ARG]), and 41 revisions for septic prosthesis (septic revision group [SRG]) based on the Musculoskeletal Infection Society (MSIS) criteria. ResultsThe serum and synovial CRP levels were significantly higher in the SRG than the other two groups (SRG serum CRP=75.6mg/L vs. ARG serum CRP=6mg/L and CG serum CRP=2.7mg/L, p<0.001; SRG synovial CRP=31.5mg/L vs. CG synovial CRP=2.6mg/L and ARG synovial CRP=1.7mg/L, p<0.001). The positive likelihood ratios (LR+) were very similar for both the synovial CRP cut-off value of 4.4mg/L (LR+=7.04; sensitivity [Se] 82.5%, specificity [Sp] 88.3%) and the serum CRP cut-off value of 9mg/L (LR+=6.3; Se 87.5%, Sp 86.1%). ConclusionThis study showed that synovial CRP testing was not more discriminating than serum CRP in the diagnosis of hip and knee PJI. A serum CRP level greater than 9mg/L was a sign of PJI. Level of evidenceIII; case-control study.

Clinical utility of procalcitonin in febrile infants younger than 3\u2009months of age visiting a pediatric emergency room: a retrospective single-center study

BackgroundFever in infants under 90 days of age is highly likely to be caused by a severe bacterial infection (SBI) and it accounts for a large number of patients visiting the pediatric emergency room. In order to predict the bacterial infection and reduce unnecessary treatment, the classic classification system is based on white blood cell (WBC) count, urinalysis, and x-ray, and it is modified and applied at each center by incorporating recently studied biomarkers such as c-reactive protein (CRP) or procalcitonin (PCT). This study analyzed the usefulness of PCT in predicting SBI when applied along with the existing classification system, including CRP, among infants less than 90 days old who visited with a fever at a single institution pediatric emergency center.MethodsWe retrospectively reviewed the medical records of patients younger than 3 months of age who presented with fever at the Seoul Asan Medical Center pediatric emergency room between July 2017 and October 2018.ResultsA total of 317 patients were analyzed, and 61 were diagnosed with SBI, among which urinary tract infection (UTI) accounted for the largest proportion (55/61, 90.2%). There were differences in WBC, neutrophil proportion, CRP, and PCT between the SBI group and the non-SBI group, and the AUC values of WBC, CRP, and PCT were 0.651, 0.804, and 0.746, respectively. When using the cut-off values of CRP and PCTs as 2.0 mg/dL and 0.3 ng/mL, respectively, the sensitivity and specificity for SBI were 49.2/89.5, and 54.1/87.5, respectively. WBC, CRP, and PCT were statistically significant for predicting SBI in multivariate analysis (odds ratios 1.066, 1.377, and 1.291, respectively). When the subjects were classified using the existing classification criteria, WBC and CRP, the positive predictive value (PPV) and negative predictive value (NPV) were 29.3 and 88.7%, respectively, and when PCT was added, the PPV and NPV were 30.7 and 92%, respectively, both increased.ConclusionPCT is useful for predicting SBI in children aged 3 months or less who visit the emergency room with a fever. It is useful as a single biomarker, and when used in conjunction with classic biomarkers, its diagnostic accuracy is further increased.

Validation of the conventional Glasgow Prognostic Score and development of the improved Glasgow Prognostic Score in patients with stage 0-III colorectal cancer after curative resection.

AimMany inflammation‐nutrition scores, including the Glasgow Prognostic Score (GPS), have been reported as prognostic biomarkers in patients with colorectal cancer (CRC). We aimed to examine the predictive ability of the GPS and to improve the GPS.MethodsWe included a total of 438 patients with stage 0‐III CRC who underwent curative surgery from 2010 to 2013. They were divided into a training set comprising 221 patients and a validation set comprising 227 patients, according to the date of surgery. In the training set, the GPS was verified using a Cox regression model, and cut‐off values for C‐reactive protein (CRP) and albumin for relapse‐free survival (RFS) were calculated using receiver operating characteristics (ROC) curves. The improved GPS (iGPS) was developed with additional optimal cut‐off values. We also compared the iGPS with the conventional GPS in the validation set.ResultsThe high GPS (GPS: 1‐2) was correlated with RFS and overall survival (OS) in the training set. Cut‐off values of CRP and albumin for RFS were 1.6 and 3.9, and we modified the GPS accordingly, adding the cut‐off values of 2 and 3.9 to CRP and albumin, respectively. In the validation set, a high iGPS was an independent prognostic factor for RFS (hazard ratio [HR]: 2.273; 95% confidence interval [CI]: 1.212‐4.364; P = .011), although the conventional GPS was not.ConclusionThe iGPS was a more accurate prognostic predictor for patients with stage 0‐III CRC.

Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study.

Anastomotic leak can adversely affect the outcome of surgery especially if detected late. The present study was carried out to detect the anastomotic leak early in the postoperative period using serial estimation of procalcitonin (PCT) and C-reactive protein (CRP). A single centre prospective cohort study was done on patients undergoing elective gastrointestinal surgery with anastomosis. Serial estimation of serum procalcitonin and C reactive protein was done on the first five postoperative days. Other parameters such as hemoglobin, total protein, albumin and WBC counts were noted perioperatively. Patients were followed up to 60th postoperative day to assess for anastomotic leak, wound infection and other septic foci. Eighty-four patients were included in the study. Anastomotic leak rate was 26.19% (22/84) and 3/22 patients died in the anastomotic leak group. Wound infection rate was 23.81%. The cut off value of CRP on third postoperative day in detecting anastomotic leak was 44.322 mg/dl with sensitivity of 72.73%, specificity of 66.13% and accuracy of 59.52%. The cut off value for WBC count measured perioperatively in detecting anastomotic leak was 9470 cell/mm3 with sensitivity of 72.73%, specificity of 56.45% and accuracy of 59.74%. Serum procalcitonin, haemoglobin, total protein and albumin measured were not sensitive enough to detect the anastomotic leak early. Measuring CRP on the third postoperative day can predict anastomotic leak with a cut off value of 44.32 mg/dl. Patients with raised CRP need careful evaluation to rule out anastomotic leak before deciding on early discharge.

High serum C-reactive protein levels predict survival in patients with treated advanced lung adenocarcinoma.

BackgroundThe prognosis of non-small cell lung cancer (NSCLC) varies greatly depending on whether or not it can receive molecular-targeted drug treatment including epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). We investigated the clinical utility of C-reactive protein (CRP) levels measured at the time of diagnosis in EGFR-mutant and wild-type NSCLC patients who had undergone first-line therapy.MethodsSerum CRP levels were analyzed in 213 patients, of whom 89 patients had advanced EGFR-mutated NSCLC who underwent first-line EGFR-TKI treatment. We used Cox proportional hazards models to study the relationship between CRP and overall survival (OS). CRP cutoff values were obtained from the receiver operating characteristic curve.ResultsMean serum CRP level in treated NSCLC patients were not significantly different in patients with or without EGFR mutations. The optimal CRP cutoff values were 8.1 mg/L for EGFR-mutated NSCLC and 16.7 mg/L for EGFR-wild NSCLC. Based on multivariate analysis, high CRP level (EGFR-mutated, HR: 2.479, 95% CI: 1.331–4.619, P=0.004; EGFR-wild, HR: 3.625, 95% CI: 2.149–6.116, P<0.001) was a significant and independent negative prognostic factor for OS in patients with or without EGFR mutations.ConclusionsHigh CRP levels predicted a lack of response to treatment in patients with advanced lung adenocarcinoma with or without EGFR mutations. Thus, the CRP level is a good and easy to use prognostic factor and objective indicator for clinical practice.

Postoperative C-reactive protein as a predictor of postoperative pancreatic fistula and hospital readmission following pancreaticoduodenectomy

Introduction: Postoperative pancreatic fistula (POPF) is the Achilles heel following Pancreaticoduodenectomy (PD).Early prediction of POPF has direct influence on patient management and outcome. This study aimed at identifying role of C-reactive protein (CRP) on first postoperative day (POD1) as predictor of clinically relevant pancreatic fistula (CR-POPF) and at discharge as a predictor of hospital readmission. Methods: A prospective observational quantitative study was performed on 49 patients over one year who underwent PD. Clinical, biochemical, intraoperative and pathological characteristics were recorded. Quantitative serum CRP was sent on POD1 and at discharge. POPF was graded according to International Study Group in Pancreatic Surgery 2016.Diagnostic accuracy of CRP on POD1 to predict CR-POPF and at discharge to predict 90 day readmission were assessed by Receiver Operating Characteristics (ROC) curve analysis and cut-off value of CRP was calculated. Results: Overall morbidity was 57.1% with mortality of 4.1%.Bile leak occurred in 38.8%.CR-POPF developed in 26.5% and cholangitis was independent risk factor(p< 0.05). Readmission rate was 14.3%. ROC curve analysis showed POD1 CRP level >100mg/l as a predictor of CR-POPF (AUC: 0.687; 95%CI [0.522-0.852] and CRP>50mg/L at discharge as a significant predictor of hospital readmission (AUC: 0.807 (95%CI [0.607-0.100], p< 0.05). Conclusion: CRP is a reliable predictor of CR-POPF and hospital readmission, thus should be utilized in patient management. Keywords: C-reactive protein; Pancreaticoduodenectomy, Postoperative pancreatic fistula; Readmission

HAEMATOLOGICAL PARAMETERS AND C-REACTIVE PROTEIN IN PREDICTION OF DISEASE SEVERITY AND MORTALITY IN PATIENTS WITH SEPSIS

Sepsis is a life-threatening condition characterized by a systemic inflammatory response of the body caused by a severe infection. The aim of this study was to examine the importance of hematological parameters and c-reactive protein (CRP) in the diagnosis of sepsis, assessment of disease severity, and prediction of final outcome of these patients. The prospective study included 106 hospitalized patients with a clinical diagnosis of sepsis. Haematological parameters and CRP correlated with sepsis stage, and using ROC (Receiver operating characteristic) analysis were evaluated in the prediction of the final outcome of these patients. Among haematological parameters, patients with sepsis had a significantly higher proportion of total unsegmented neutrophil granulocytes, a lower percentage of lymphocytes, as well as a lower total platelet count (p&lt;0.05 for all measurements). An excellent positive correlation was found between serum CRP concentration and disease stage (r=0.77). The best predictive value for the presence of sepsis was shown by CRP at the cut- off value of 165 mg/L (AUC 0.98), followed by the percentage of unsegmented neutrophil granulocytes for the cut-off value of 15.5 (AUC 0.67), and the percentage of lymphocytes less than 9.9 (AUC 0.66), platelets lower than 118x109/L (AUC 0.63). At the CRP cut-off value of 294.7 mg/L (AUC 0.84; 95% CI 0.74-0.93), death could be predicted in 80.95% of patients with sepsis, with the sensitivity of 43.75% and the specificity of 89.71% (p&lt;0.0001). By monitoring changes in haematological parameters and CRP concentration in combination with other clinical and laboratory indicators, disease severity and final outcome in patients with sepsis can be predicted. Key words: CRP, lymphocytes, platelets, SIRS, sepsis

Age over 65 years and high levels of C-reactive protein are associated with the risk of preoperative deep vein thrombosis following closed distal femur fractures: a prospective cohort study

BackgroundIn this study, we investigated the epidemiological characteristics and predictors of preoperative new-onset deep vein thrombosis (DVT) in adult patients with closed distal femur fractures (DFFs).MethodsThe study was designed as a prospective cohort trial at the Third Hospital of Hebei Medical University. From October 2018 to June 2020, a total of 160 patients with closed DFFs were enrolled to assess the location and prognosis of preoperative DVT. The patients were followed up for 2 months. Duplex ultrasonography (DUS) was used to diagnose patients with DVT. The patients were divided into two groups (DVT group and non-DVT group). The DVT was then classified into proximal, distal, and mixed thromboses. The Mann-Whitney U test or t test, receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to analyze the adjusted predictors of DVT.ResultsThe overall incidence of preoperative DVTs was 52.5% (n = 84), which was diagnosed at a mean period of 3.1 days after injury. Among patients diagnosed with DVTs, 50.0% (n = 42) had distal thrombosis while 47.6% (n = 40) had mixed thrombosis. The calf muscle veins were the most common sites of DVTs (90.5%, n = 76). Of note, 45.2% (n = 38) of diagnosed DVTs were completely recanalized at a mean period of 12.0 days after the initial (first) diagnosis. Multivariate analysis revealed that age of ≥ 65 years of age (odds ratio [OR], 4.390; 95% confidence interval [CI] 1.727–11.155; p = 0.002), C-reactive protein (CRP) levels exceeding 11 mg/L (OR 4.158; 95% CI 1.808–11.289; p = 0.001), platelet (PLT) levels over 217 × 109/L (OR, 2.55; 95% CI 1.07–6.07; p = 0.035), D-dimer levels over 1.0 mg/L (OR 3.496; 95% CI 1.483–8.237; p = 0.004), and an American Society of Anesthesiologists (ASA) score of III-V (OR 2.753; 95% CI 1.216–6.729; p = 0.026) were the independent risk factors of preoperative DVT.ConclusionsHigh levels of CRP, PLT, D-dimer, ASA, and ≥ 65 years of age increase the risk of preoperative DVTs in adult patients with closed DFFs. Thus, the prediction of preoperative DVTs can significantly be improved by identifying older patients over the age of 65, and establishing the biochemical cut-off values of CRP, PLT, ASA, and D-dimer.Trial registrationNo. 2018-026-1, 24 October 2018, prospectively registered.This trial was registered prospectively on 24 October 2018 before the first participant was enrolled. This study protocol conformed to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the study on the factors of prognosis for patients with fractures. Data used in this study were obtained from the patients who underwent orthopedic surgery between October 2018 and June 2020.

The Diagnostic Performance of Interleukin-6 and C-Reactive Protein for Early Identification of Neonatal Sepsis.

Interleukin-6 (IL-6) and C-reactive protein (CRP) are being used for diagnosis of sepsis. However, studies have reported varying cut-off levels and diagnostic performance. This study aims to investigate the optimal cut-off levels and performance of IL-6 and CRP for the diagnosis of neonatal sepsis. The study was conducted at the University Hospital of Leipzig, Germany from November 2012 to June 2020. A total of 899 neonates: 104 culture proven sepsis, 160 clinical sepsis, and 625 controls were included. Blood culture was performed using BacT/ALERT 3D system. IL-6 and CRP were analyzed by electrochemiluminescent immunoassay and immunoturbidimetric assay, respectively. Data were analyzed using SPSS 20 statistical software. Among neonates with proven sepsis, the optimal cut-off value of IL-6 was 313.5 pg/mL. The optimal cut-off values for CRP in 5 days serial measurements (CRP1, CRP2, CRP3, CRP4, and CRP5) were 2.15 mg/L, 8.01 mg/L, 6.80 mg/L, 5.25 mg/L, and 3.72 mg/L, respectively. IL-6 showed 73.1% sensitivity, 80.2% specificity, 37.6% PPV, and 94.8% NPV. The highest performance of CRP was observed in the second day with 89.4% sensitivity, 97.3% specificity, 94.5% PPV, and 98.3% NPV. The combination of IL-6 and CRP showed increase in sensitivity with decrease in specificity. In conclusion, this study defines the optimal cut-off values for IL-6 and CRP. The combination of IL-6 and CRP demonstrated increased sensitivity. The CRP 2 at cut-off 8.01 mg/L showed the highest diagnostic performance for identification of culture negative clinical sepsis cases. We recommend the combination of IL-6 (≥313.5 pg/mL) and CRP1 (≥2.15 mg/L) or IL-6 (≥313.5 pg/mL) and CRP2 (≥8.01 mg/L) for early and accurate diagnosis of neonatal sepsis. The recommendation is based on increased sensitivity, that is, to minimize the risk of any missing cases of sepsis. The CRP2 alone at cut-off 8.01 mg/L might be used to identify clinical sepsis cases among culture negative sepsis suspected neonates in hospital settings.

Presence of Sensory Neuropathy Modifies the Predictive Value of Inflammatory Biomarkers for Osteomyelitis in Diabetic and Non-Diabetic Patients with Foot Infections

To investigate the predictive value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in persons with and without diabetes with osteomyelitis (OM). We evaluated 455 patients in a retrospective cohort study of patients admitted to the hospital with diabetic foot OM (n = 177), diabetic foot soft-tissue infections (STIs) (n = 176), nondiabetic OM (n = 51), and nondiabetic STIs (n = 51). Infection diagnosis was determined through bone culture, histopathologic examination for OM, and/or imaging (magnetic resonance imaging/single-photon emission computed tomography) for STI. The optimal cutoff values of ESR and CRP in predicting OM were determined by receiver operating characteristic curve analysis. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were determined through contingency tables. In persons without diabetes with STI or OM, the mean ESR and CRP differences were 10.0 mm/h and 2.6 mg/dL, respectively. In contrast, persons with diabetes had higher levels of each: 24.8 mm/h and 6.8 mg/dL, respectively. As a result, ESR and CRP predicted OM better in patients with diabetes. However, when patients were stratified by neuropathy status, ESR remained predictive of OM in diabetic patients with neuropathy (75% sensitivity, 58% specificity) but not in diabetic patients without neuropathy (50% sensitivity, 44% specificity). Also, CRP remained predictive irrespective of neuropathy status. A similar trend was observed in patients without diabetes. Previous studies have reported that ESR and CRP are predictive of OM. However, this study suggests that neuropathy influences the predictive value of inflammatory biomarkers. The underlying mechanisms require further study.

Relationship Between CRP and a Lin Routine Abdominal Procedures: A Systematic Analysis

Anastomotic leakage (AL) is the most drastic complication specific to intestinal surgery, but it is frequently diagnosed late. Early diagnosis and prompt treatment can reduce morbidity and mortality. The aim of the study was to evaluate the diagnostic accuracy of serial C – reactive protein (CRP) in early detection of anastomotic leakage in routine abdominal procedures. The study was conducted over a period of 1 year from 1 st January 2015 to 31th December 2015 in the Department of Surgery of DMCH. Within the period, 100 patients were prospectively selected for the study irrespective of age and sex. CRP of all patients was measured on 3rd and 5thpost operative day (POD). Data was collected through questionnaire. 27 patients had anastomotic leakage. Mean age of the leakage and non leakage were 44.77 ± 15.00 and 48.09 ± 13.68 years respectably (p = 0.308). There was male predominance in both the groups.Most (55%) of the anastomotic leakage (AL) occurred in the pancreaticojejunostomy patients. In 3rdpost operative day (POD) the mean ± SD CRP with the anastomotic leakage (AL)group and non-anastomotic leakage(non AL)group were 180.88±61.63 and 96.65±44.76 (p&lt;.0001). In 5 th post operative day (POD) the mean CRP of anastomotic leakage(AL) and non anastomotic leakage (non-AL) were consecutively 121.18±33.64 and 45.60±28.71 (p&lt;.0001). Cutoff value for CRP of 143 mg/l on POD 3 was associated with development of anastomotic leakage (AL). Patients with CRP levels at or below 143 mg/l on POD 3 can be safely discharged after elective abdominal surgery

One-step non-competitive fluorescence polarization immunoassay based on a Fab fragment for C-reactive protein quantification

A non-competitive fluorescence polarization immunoassay (FPIA) using a Fab fragment was developed for large molecule quantification. Most conventional FPIAs are homogeneous and competitive immunoassays. With competitive FPIAs, it has been difficult to obtain sufficient detection sensitivity when targeting large molecules like proteins. To overcome this fundamental drawback, we report a non-competitive FPIA using a fluorescence-labeled Fab fragment. C-reactive protein (CRP) was used as model substance for validation of the Fab-based non-competitive FPIA. Quantitative analysis of CRP in phosphate buffered saline (PBS) was successfully achieved and the limit of detection (LOD) of CRP in PBS was 207 ng/mL. Moreover, using far-red emitting fluorescent dye (HiLyte Fluor™647) as a fluorescent labeling substance of Fab fragment, we measured CRP in human serum without pretreatment of a sample in 10 min around the cut-off value of CRP (10 μg/mL). The LOD of CRP in human serum was 1.58 μg/mL. In our proposed method, the reaction was completed in a simple one-step mixing with only one type of fluorescence-labeled Fab fragment reagent, and no washing operation was required. Therefore, rapid protein quantification was achieved with a greatly simplified procedure.

Performance of prognostic markers in pediatric sepsis

ObjectiveTo evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), ferritin, lactate, C-reactive protein (CRP), and leukocytes, alone and in combination, in pediatric patients with sepsis admitted to the pediatric intensive care unit (PICU). MethodsA retrospective study was conducted in a PICU in Brazil. All patients aged 6 months to 18 years admitted with a diagnosis of sepsis were eligible for inclusion. Those with ferritin and C-reactive protein measured within 48h and lactate and leukocytes within 24h of admission were included in the prognostic performance analysis. ResultsOf 350 eligible patients with sepsis, 294 had undergone all measurements required for analysis and were included in the study. PIM2, ferritin, lactate, and CRP had good discriminatory power for mortality, with PIM2 and ferritin being superior to CRP. The cutoff values for PIM2 (> 14%), ferritin (> 135ng/mL), lactate (> 1.7mmol/L), and CRP (> 6.7mg/mL) were associated with mortality. The combination of ferritin, lactate, and CRP had a positive predictive value of 43% for mortality, similar to that of PIM2 alone (38.6%). The combined use of the three biomarkers plus PIM2 increased the positive predictive value to 76% and accuracy to 0.945. ConclusionsPIM2, ferritin, lactate, and CRP alone showed good prognostic performance for mortality in pediatric patients older than 6 months with sepsis. When combined, they were able to predict death in three-fourths of the patients with sepsis. Total leukocyte count was not useful as a prognostic marker.

Predictors of Acute Pyelonephritis in Infants Less Than 4 Months Old with Febrile Urinary Tract Infection

Background: Detecting early predictors of acute pyelonephritis (APN) is essential for the prognosis, but few studies have focused on young infants specifically. Objectives: The aim of our research was to determine the relationship between APN and laboratory parameters in the age group less than 4 months. Methods: This retrospective study included patients aged less than 4 months with first time febrile urinary tract infection (UTI) between January 2012 and December 2018. White blood cells (WBC), C-reactive protein (CRP), and blood neutrophil/lymphocyte ratio (NLR) were analyzed. Patients were divided into two groups according to the presence of renal defects on dimercaptosuccinic acid (DMSA) scans. Results: In total, 205 patients were screened; 107 patients were in the APN group, and 98 patients were in the non-APN group. Compared with the non-APN group, the APN group showed significant differences in therapeutic response time (TRT), CRP, and NLR (all P values &lt; 0.001). Multiple logistic regression analysis revealed that CRP, NLR, and TRT were independent risk factors for APN (P ≤ 0.001, 0.003, and 0.004, respectively). The area under the receiver operating characteristic (ROC) curve was 0.774 for CRP (P &lt; 0.001). The optimum cut-off value for CRP was 4.27 mg/dL, with the highest sensitivity and specificity (70.1% and 73.5%, respectively). Conclusions: In the age group less than 4 months, without the image diagnosis, we could treat the patients as APN for longer antibiotic duration if CRP ≥ 4.27 mg/dL.

Significance of Pretreatment C-Reactive Protein, Albumin, and C-Reactive Protein to Albumin Ratio in Predicting Poor Prognosis in Epithelial Ovarian Cancer Patients

To investigate the prognostic significance of pretreatment C-reactive protein (CRP), albumin, and the CRP to albumin ratio (CRP/Alb) in epithelial ovarian cancer (EOC) patients. Clinical data from 308 EOC patients between April 2007 and March 2016 were collected and retrospectively reviewed. The cutoff values for CRP, albumin, and CRP/Alb were defined by receiver operating characteristics (ROC) analyses. Univariate or multivariate analysis was conducted to evaluate the prognostic significance of these factors for disease-specific survival. The cutoff values for CRP, albumin, and CRP/Alb were 0.76, 3.8, and 0.048 by ROC analysis, respectively. Cox regression analyses demonstrated that an elevated CRP/Alb is an independent predictor of short disease-specific survival irrespective of clinical stage or optimal surgery rate. When examined according to clinical stage, elevated CRP/Alb was associated with short disease-specific survival in both early-stage and advanced-stage patients. Cox regression analyses demonstrated that an elevated CRP, but not lower albumin, is also an independent predictor of short disease-specific survival. When two prognosticators were compared, CRP/Alb was found to be superior to CRP for predicting disease-specific survival in EOC patients. Pretreatment elevated CRP/Alb is a predictor of shorter survival in EOC patients regardless of clinical stage.