Diagnostic Accuracy Of C-reactive Protein Research Articles

Evaluating the Diagnostic Accuracy of C-Reactive Protein in Diagnosing Pneumonia in Children Using Blood Culture as the Gold Standard

Evaluating the Diagnostic Accuracy of C-Reactive Protein in Diagnosing Pneumonia in Children Using Blood Culture as the Gold Standard

Diagnostic Accuracy of C-Reactive Protein in Acute Appendicitis

Objective: To determine diagnostic accuracy of C-reactive protein in acute appendicitis. Study Design: Cross-sectional study. Place and Duration of Study: Surgical unit Combined Military Hospital Gujranwala Pakistan, from Apr 2019 to Jan 2021. Methodology: One hundred and twenty patients were included in the study following the inclusion criteria after their written permission and willingness. C-reactive protein levels were sent pre-operatively to the Pathology department of Combined Military Hospital Gujranwala. Patients were operated on by two classified surgeons. After open and laparoscopic appendectomies, specimens were sent to Histopathologists at Armed Forces Institute of Pathology Rawalpindi. Results were compared to determine the diagnostic accuracy of C-reactive protein. Results: Out of 120 patients, 72(60%) were males and 48(40%) were females. The diagnostic accuracy of C-reactive protein in acute appendicitis was calculated by keeping tissue diagnosis histopathology as the gold standard, where 82(68.33%) were true positive, 7(5.84%) were false positive, 13(10.83%) were true negative, and 18(15%) were false negative. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 89.13%, 67.86%, 90.11%, 65.52% and 84.17% respectively. Conclusion: The of C-reactive protein level test for the diagnosis of acute appendicitis was very sensitive but not very specific. C-reactive protein levels should be measured routinely in suspected cases of acute appendicitis, along with Total Leucocyte Count and ultrasound abdomen, as a useful marker for early diagnosis, thus reducing negative appendectomy rates.

Diagnostic accuracy study of globular sedimentation rate and C-reactive protein in patients with systemic lupus erythematosus and fever admitted to a Social Security hospital in Lima, Peru, 2010–2019

IntroductionIn patients with systemic lupus erythematosus (SLE) and fever, the causes are infection and/or activity. We assessed the diagnostic accuracy of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to discern these causes. MethodsWe reviewed medical records of patients with SLE and fever hospitalized from 2010 to 2019. Based on two categories of cause of fever (infection with-or-without activity versus activity alone), we computed ROC curves, areas under the curve (AUC) and best cut-off values for ESR, parameter ESR, CRP and ESR/CRP ratio. In addition, we calculated sensitivity, specificity, and predictive values. ResultsWe included 40 cases (34 women) with an average age of 35.5 years. The main cause of fever was the coexistence of infection and activity (17/40; 43%), followed by fever only due to activity (14/40; 35%). The most frequent infection was pneumonia (10/40; 25%) and the most common activity was renal (21/40; 53%). To diagnose “fever due to infection with-or-without activity”, compared to “fever only due to activity”, CRP had an AUC: 0.86 (95% CI: 0.75–0.97) with 5.4 mg/dl as the best cut-off value (Se: 76.9%; Sp: 85.7%; PPV: 90.9; NPV: 66.6%). To diagnose “fever due to activity only”, compared to “fever due to infection with or without activity”, the ESR/CRP ratio had an AUC: 0.83 (95% CI: 0.68–0.98) with 21.42 as the best cut-off value (Se: 78.6%; Sp: 84.6%; PPV: 73.3%; NPV: 88.0%). ConclusionCRP and ESR/CRP ratio, which are routine tests in these cases, are potentially useful in discerning causes of fever in SLE patients. These findings should be confirmed in future studies.

C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery

BackgroundSerum C-reactive protein (CRP) is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications, but most studies on optimal cut-off values are retrospective with a small sample of patients. The aim of this study was to determine the accuracy and optimal cut-off value of CRP for anastomotic leakage in patients following esophagectomy for cancer.Materials and methodsConsecutive minimally invasive esophagectomy for esophageal cancer patients was included in this prospective study. Anastomotic leakage was confirmed if a defect or leakage of oral contrast was seen on a CT scan, by endoscopy or if saliva was draining from the neck incision. Diagnostic accuracy of CRP was assessed by receiver operator curve (ROC) analysis. Youden’s index was adopted to determine the cut-off value.ResultsA total of 200 patients were included between 2016 and 2018. Postoperative day 5 showed the highest area under the ROC (0.825) and optimal cut-off value of 120 mg/L. This resulted in a sensitivity of 75%, specificity of 82%, negative predicting value of 97%, and positive predicting value of 32%.ConclusionsCRP on postoperative day 5 can be used as a negative predictor for and can be used as a marker to raise suspicion of anastomotic leakage following esophagectomy for esophageal cancer. When CRP exceeds 120 mg/L on postoperative day 5, additional investigations should be considered.

C-reactive protein is a predictor of severe infective complications following gastrectomy-a retrospective analysis.

Post-operative complications are the main contributing factor to increased length of stay, increased cost of care and short-term mortality experienced by patients following gastrectomy. The purpose of this study was to determine the diagnostic accuracy of C-reactive protein (CRP) in predicting complications following gastrectomy. This may assist clinicians to make better informed clinical decisions in the post-operative period. A retrospective analysis of a prospectively maintained database was performed. Sixty patients who underwent gastrectomy for gastric cancer were included. Demographic information, operative data and post-operative details such as complications, unplanned intensive care unit (ICU) admission and readmission to hospital were analysed. Complications were further analysed based on whether they were either infective or non-infective in nature. Receiver operator characteristic (ROC) analysis was performed to examine the association between CRP and post-operative morbidity. Optimum cut-offs were determined using the Youden's index. From the second post-operative day (POD), CRP levels were able to predict subsequent severe infective (SI) complications following gastrectomy [area under the curve (AUC): 0.789, 95% CI : 0.636-0.941]. An optimum cut-off of 180 mg/L resulted in a sensitivity of 87.50%. The negative predictive value (NPV) at this point was 96.30%. CRP is a strong negative predicter of SI complications following gastrectomy. This suggests early CRP values may be useful in prompting early investigation or facilitating safer, earlier discharge from hospital. Health services may benefit by determining similar cut-offs based on their own unique patient populations.

A study of clinical utility of peri operative c- reactive protein testing in general surgery at tertiary care centre

Background and objectives Clinical diagnosis of infections, inflammatory diseases, and response monitoring can be done by C reactive protein (CRP), an acute-phase protein. CRP measurement in the perioperative period was studied, and patterns of change were analyzed, for elective general surgical patients. Study aimed to test the efficacy of C - reactive protein as a predictor for surgical stress and diagnostic accuracy to detect early postoperative infectious complications. Objective of this study was to estimate perioperative serum C - reactive protein level in patients undergoing elective surgeries. 1. To find out the relation between serum C-reactive protein level and severity of surgical stress. 2.To find out diagnostic accuracy of C-reactive protein to detect early postoperative infectious complications.

Diagnostic accuracy of C-reactive protein and procalcitonin in the early diagnosis of infections after laparoscopic rectal cancer surgery.

We aimed to examine the diagnostic accuracy of postoperative procalcitonin (PCT) and C-reactive protein (CRP) in the detection of infectious complications in patients after laparoscopic rectal cancer surgery, as opposed to all colorectal surgery. Between December 2018 and December 2020, 204 patients who underwent laparoscopic rectal cancer surgery were enrolled retrospectively. The PCT, CRP and white blood cell (WBC) count were measured before surgery and on postoperative days (PODs) 3 and 5. Diagnostic accuracy was determined by the area under the receiver operating characteristic curve (AUC). Net Reclassification Index (NRI) was used to calculate the ability to correct reclassification. Infectious complications occurred in 36 patients (17.6%), including 17 cases of anastomotic leakage (AL) (8.3%). The AUCs of PCT and CRP in predicting infectious complications on POD 3 were 0.690 and 0.731, respectively, which were better than those on POD 5 (AUC 0.666 and 0.697, respectively). PCT with an optimal cutoff value of 1.10ng/mL (AUC 0.792, specificity 78.6%, negative predictive value [NPV] 96.6%), CRP with an optimal cutoff value of 109.5mg/L (AUC 0.760, specificity 78.6%, NPV 96.1%) on POD 3 had superior diagnostic accuracy in predicting AL, both better than WBC (AUC 0.627). The AUC of combining PCT and CRP on POD 3 in predicting AL was 0.851, with a specificity of 79.7% and NPV of 97.4%, and the NRI was estimated to be 7.0%. Both PCT and CRP on POD 3 are excellent negative predictors for early monitoring of infectious complications, especially AL, in patients undergoing laparoscopic rectal cancer surgery.

Role of C-reactive Protein, Leucocyte and Neutrophil Count in Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is the most common cause of surgical acute abdomen and appendicectomy is the most commonly done surgery. Accurate preoperative diagnosis can reduce negative appendicectomy rate. Objective: To evaluate the diagnostic accuracy of C-reactive protein (CRP), total leucocyte count (TLC) and neutrophil count in patients operated after clinical diagnosis of acute appendicitis. Materials and Methods: This cross-sectional observational study was conducted among 100 patients at Combined Military Hospital, Dhaka from August 2012 to January 2013. Serum CRP level was measured by latex agglutination method which is a qualitative test and level of 6 mg / L was considered positive. TLC and neutrophil count were estimated by processing blood sample through automated haematology analyzer. TLC level of 10.5 x 109/L and differential count of neutrophil more than 75% were considered elevated. Results: Out of 100 cases the mean age of the patients was 21.7 years and 65 patients were male and 35 patients were female with male to female ratio 1.85:1. Majority cases (54%) were in the age group of 11-20 years. Clinical diagnosis was correct in 93% cases and negative appendicectomy rate was 07% (p<0.001). Appendix was found mostly inflamed (83%) and gangrenous (10%). CRP was highly sensitive (84.9%) and specific (85.7%) with diagnostic accuracy of 85%. TLC was also found equally sensitive and specific with diagnostic accuracy of 83%. Overall diagnostic accuracy of neutrophil was 76%. Conclusion: Diagnosis of acute appendicitis is essentially clinical supported by simple laboratory investigations like TLC and neutrophill count. Elevated levels of CRP, TLC and neutrophill count are helpful in confirming a suspected diagnosis of acute appendicitis. Appendicitis is very unlikely if the CRP, TLC and neutrophill counts are normal. JAFMC Bangladesh. Vol 17, No 1 (June) 2021: 26-29

Estudio de precisión diagnóstica de la velocidad de sedimentación globular y la proteína C reactiva en pacientes con lupus eritematoso sistémico y fiebre admitidos en un hospital de la Seguridad Social en Lima, Perú, 2010-2019

IntroductionIn patients with systemic lupus erythematosus (SLE) and fever, the causes are infection and/or activity. We assessed the diagnostic accuracy of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to discern these causes. Materials and methodsWe reviewed medical records of patients with SLE and fever hospitalized from 2010-2019. Based on two categories of cause of fever (infection with-or-without activity versus activity alone), we computed ROC curves, areas under the curve (AUC) and best cut-off values for ESR, parameter ESR, CRP and ESR/CRP ratio. In addition, we calculated sensitivity, specificity, and predictive values. ResultsWe included 40 cases (34 women) with an average age of 35.5 years. The main cause of fever was the coexistence of infection and activity (17/40; 43%), followed by fever only due to activity (14/40; 35%). The most frequent infection was pneumonia (10/40; 25%) and the most common activity was renal (21/40; 53%). To diagnose”fever due to infection with-or-without activity”, compared to “fever only due to activity”, CRP had an AUC: .86 (95% CI: .75-.97) with 5.4mg/dl as the best cut-off value (Se: 76.9%; Sp: 85.7%; PPV: 90.9; NPV: 66.6%). To diagnose “fever due to activity only”, compared to “fever due to infection with or without activity”, the ESR/CRP ratio had an AUC: .83 (95% CI: .68-.98) with 21.42 as the best cut-off value (Se: 78.6%; Sp: 84.6%; PPV: 73.3%; NPV: 88.0%). ConclusionCRP and ESR/CRP ratio, which are routine tests in these cases, are potentially useful in discerning causes of fever in SLE patients. These findings should be confirmed in future studies.

Diagnostic accuracy of C-reactive protein to rule out infectious complications following hip fracture surgery.

Background and Objective:Knowledge of the C-reactive protein trend and deviation from the expected value may give an early indication of a possible postoperative infection. According to previous studies, CRP appears to be a more sensitive and specific marker of postoperative infections than ESR and white cell count. This study was conducted to determine the diagnostic accuracy of C-reactive protein to rule out surgical site infection in patients undergoing hip fracture surgery.Methods:This cross-sectional study was conducted at The Indus Hospital and Health Network, Karachi from July 1, 2018 to February 24, 2020. All operative hip fracture patients aged 11-90 years were included. CRP was done on admission, days 3, 14 and 28. Wound assessment was done using the criteria of the Center of Disease Control and prevention on postoperative days 3, 14 and 28. Data was analyzed using STATA version 16.Results:Out of 152 patients, 11(7.2%) developed infection. One patient (0.7%) presented with the infection on day three post-surgery, eight (5.3%) and two (1.3%) patients on days 14 and 28 respectively. CRP levels at admission had poor diagnostic accuracy for diagnosing infection at 14th and 28th day post-surgery respectively (AUC=0.490 and 0.447). CRP levels measured on post-op Day-3 (cutoff value 230mg/dl) had good diagnostic accuracy for diagnosing infection at 14th and 28th day post-surgery respectively (AUC=0.819 and 0.818).Conclusion:CRP level at post-operative day three is a sensitive indicator of infection after hip fracture surgery.

Evaluation of diagnostic accuracy of C-Reactive protein as a biomarker of spontaneous bacterial peritonitis in patients having decompensated chronic liver disease.

Objective: The objective of this study was to evaluate the diagnostic accuracy of C Reactive Protein (CRP) in diagnosing spontaneous bacterial peritonitis (SBP) in patients with decompensated chronic liver disease. Study Design: Cross Sectional study. Setting: Department of Medicine Sheikh Khalifa Bin Zayed Hospital Rawalakot Azad Kashmir. Period: Feb 2018 to Dec 2018. Material & Methods: One hundred subjects with decompensated liver disease were recruited in this study after fulfilling inclusion criteria. The patients’ medical record number, age and gender was recorded upon admission. Baseline investigations including complete blood count, urine examination and chest X ray were done. Abdominal ultrasound was performed for detecting the presence of ascitic fluid. SBP was diagnosed if > 250 mm3 neutrophils are detected in the ascitic fluid. Serum CRP was detected and reported in mg/L. Results: SBP was detected in 32.8% of the patients having decompensated chronic liver disease. CRP levels were > 29.5mg/L in 36% of the patients while in 64% patients the CRP levels were < 29.5mg/L. The sensitivity of CRP for the diagnosis of SBP was calculated as 83.61% while the specificity was calculated as 87.2%. A positive predictive value was estimated as 76.12% and a negative predictive value was 91.59% while the diagnostic accuracy was calculated as 86.02% from the given data. Conclusion: CRP is a reliable diagnostic biomarker for spontaneous bacterial peritonitis in subjects having complications of chronic liver disease.

Post-operative serum procalcitonin vs. C-reactive protein as a marker of post-operative infectious complications in pancreatic surgery: A systemic review and meta-analysis

The aim of this meta-analysis was to compare the diagnostic accuracy of C-reactive protein (CRP) and Procalcitonin (PCT) between postoperative days (POD) 3 to 5 in predicting infectious complications post pancreatic surgery. A systemic literature search was performed using MEDLINE, EMBASE, and SCOPUS to identify studies evaluating the diagnostic accuracy of PCT and CRP as a predictor for detecting infectious complications between POD 3 to 5 following pancreatic surgery. A meta-analysis was performed using the random-effect model and pooled predictive parameters. Geometric means were calculated for PCT cut-offs. After applying inclusion and exclusion criteria 15 studies consisting of 2,212 patients were included in the final analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled sensitivity, specificity, Area under the curve, and diagnostic odds ratio (DOR) for day 3 CRP were respectively 62%,67% 0.772, and 6.54. Pooled sensitivity, specificity, Area under the curve, and DOR for day 3 PCT was respectively 74%,79%, 0.8453, and 11.03. Sensitivity, specificity, Area under the curve and DOR for day 4 CRP were respectively 60%, 68%, 0.8022, and 11.90. Pooled sensitivity, specificity, and DOR of postoperative day 5 PCT level in predicting infectious complications were respectively 83%,70%, and 12.9. Pooled sensitivity, specificity, Area Under a ROC Curve, and diagnostic odds ratio were respectively 50%, 70%, 0.777, and 10.19. Post-operative PCT is better marker to predict post-operative infectious complications after pancreatic surgeries and post-operative day 3 PCT has highest diagnostic accuracy.

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

Assessment of the Diagnostic Accuracy of C-Reactive Protein and Pentraxin3 in Acute Coronary Syndrome Compared with Cardiac Troponin-1

High levels of pentraxin3 reflect severity of coronary lesions as measured by coronary angiography, very low levels of serum pentraxin 3 could exclude presence of risk for those patients completely so, it is considered agood negative test. We aimed to assess the diagnostic accuracy of C-reactive protein and pentraxin3 in acute coronary syndrome compared with cardiac troponin-1 Methods: A cohort study was conducted on 100 patients and were divided into:NSTE-ACS (NSTEMI and UA) included 70 patients. Non-ACS (SCAD and non-cardiac) included 30 patients. Laboratory investigations were done . Resting 12 leads surface Electrocardiogram (ECG) was done. Echocardiography to assess the left ventricular systolic function was done. By dividing our study populations into 4 groups NSTEMI, UA, SCAD and Non-ACS (non-cardiac),There was highly statistical significant difference regarding hs-CRP, CTnI and PX3. There was statistical significant difference regarding LVEF between group I & III, I & IV, II & III and II & IV. The best cut-off value considering the diagnostic accuracy of PX3 in prediction of acute coronary syndrome is 1.6 with 94.3% sensitivity and 60% specificity, for CTnI is 0.055 with 78.6% sensitivity and 53.3% specificity. Elevated levels of hs-CRP and serum PTX3 in the early hours clearly shows that they can be used as novel markers in the diagnosis of ACS. Their estimation in the early hours of ACS aid in the diagnosis and management of ACS.

MATERNAL CRP AS A PREDICTOR OF CHORIOAMNIONITIS IN WOMEN WITH PPROM

Introduction: Preterm prelabor rupture of the membranes (PPROM) refers to spontaneous rupture of membranes in the absence of labor pains, before 37 completed weeks of gestation. Chorioamnionitis (CAM) affects many pregnancies complicated by PPROM. Finding a serum factor that could accurately predict the presence of CAM could potentially lead to more efficient management of PPROM and improved neonatal outcomes. It has been claimed that estimation of C-reactive proteins (CRP) is helpful in the diagnosis of chorioamnionitis, and this study aims to appraise such claimsObjective: To determine the diagnostic accuracy of C-reactive protein in the detection of chorioamnionitis in women with PPROM and to test sensitivity/specificity/positive predictive valve/negative predictive value of CRP in diagnosing chorioamnionitis against histopathological examination of placenta.Method: A study conducted on total 440 antenatal women, 220 cases of PROM and 220 cases with same gestation but without PPROM used as a control. A detailed obstetrical and menstrual history was taken and systemic and local examination was done. Subjects were managed expectantly with use of tocolytics, antibiotics and steroids. Frequent vital signs monitoring and hematological investigation were done. CRP levels were determined. After delivery placenta was sent for histopathological examination for the presence of chorioamnionitis.Results: CRP appears to be the most sensitive acute phase protein; rising of less than 24 hours makes it suitable to serve as a marker for diagnosing an infection. On comparing C-reactive protein levels with other laboratory tests and indicators of infection (e.g. total leucocyte count, maternal fever, maternal tachycardia, fetal tachycardia) we found CRP level to be more sensitive (100%) but less specific (45.45%) in identifying chorioamnionitis. The positive predictive value was 31.4% and negative predictive value was 100%.Conclusion: CRP is early and reliable indicator of histopathological and clinical chorioamnionitis in comparison of TLC and clinical parameter. Thus CRP can prove useful markers in identify early and subclinical infection which could lead to premature rupture of membrane.Key-words- Preterm birth, C-reactive protein, PPROM, Chorioamnionitis.

The trend of C-Reactive protein allows a safe early discharge after surgery for Crohn’s disease

Postoperative C-reactive protein (CRP) level allows to rule out infectious complications ensuring safe hospital discharge in colorectal cancer surgery. Since its clinical significance in Crohn's disease (CD) has not been studied yet, we investigated whether CRP can guide decision-making on hospital discharge in this population. Only consecutive CD patients undergoing resections with primary anastomosis and without covering stoma (2013-2017) were analysed. Pre- and post-operative CRP values, measured daily until discharge, were correlated with postoperative complications including anastomotic leakage (AL), infectious and non-infectious complications. The diagnostic accuracy of CRP in predicting AL was evaluated according to the area under the curve (AUC), using the receiver-operating characteristic (ROC) methodology. Two-hundred and fifty-one consecutive patients undergoing elective surgery for CD were selected. AL was diagnosed in 10 patients (4%). High CRP level was associated with AL on postoperative day (POD) 3-5 (p = 0.002, AUC 0.825) with a positive predictive value of 60%. CRP linear difference of 140 between POD 1 and 3 (AUC 0.800) maximizes sensitivity and specificity with a NPV of 98.6%. CRP trend, measured with the linear difference between POD 1 and 3, is able to rule out anastomotic complications with a high NPV and may allow a safe early hospital discharge after surgery for CD.

Meta-analysis of the Diagnostic Accuracy of C-Reactive Protein for Infectious Complications in Laparoscopic Versus Open Colorectal Surgery

IntroductionC-reactive protein may predict anastomotic complications after colorectal surgery, but its predictive ability may differ between laparoscopic and open resection due to differences in stress response. Therefore, the objective of this study was to perform a systematic review and meta-analysis on the diagnostic characteristics of C-reactive protein to detect anastomotic leaks and infectious complications after laparoscopic and open colorectal surgery. MethodsA systematic review was performed according to PRISMA. Studies were included if they reported on the diagnostic characteristics of postoperative day 3–5 values of serum C-reactive protein to diagnose anastomotic leak or infectious complications specifically in patients undergoing elective laparoscopic and open colorectal surgery. The main outcome was a composite of anastomotic leak and infectious complications. A random-effects model was used to perform a meta-analysis of diagnostic accuracy. ResultsA total of 13 studies were included (9 for laparoscopic surgery, 8 for open surgery). The pooled incidence of the composite outcome was 14.8% (95% CI 10.2–19.3) in laparoscopic studies and 21.0% (95% CI 11.9–30.0) for open. The pooled diagnostic accuracy characteristics were similar for open and laparoscopic studies. However, the C-reactive protein threshold cutoffs were lower in laparoscopic studies for postoperative days 3 and 4, but similar on day 5. ConclusionsThe diagnostic characteristics of C-reactive protein in the early postoperative period to detect infectious complications and leaks are similar after laparoscopic and open colorectal surgery. However, thresholds are lower for laparoscopic surgery, suggesting that the interpretation of serum CRP values needs to be tailored based on operative approach.

Nonparametric estimation of distributions and diagnostic accuracy based on group-tested results with differential misclassification.

This article concerns the problem of estimating a continuous distribution in a diseased or nondiseased population when only group-based test results on the disease status are available. The problem is challenging in that individual disease statuses are not observed and testing results are often subject to misclassification, with further complication that the misclassification may be differential as the group size and the number of the diseased individuals in the group vary. We propose a method to construct nonparametric estimation of the distribution and obtain its asymptotic properties. The performance of the distribution estimator is evaluated under various design considerations concerning group sizes and classification errors. The method is exemplified with data from the National Health and Nutrition Examination Survey study to estimate the distribution and diagnostic accuracy of C-reactive protein in blood samples in predicting chlamydiaincidence.

NEONATAL SEPSIS;

Objectives: To determine the diagnostic accuracy of C-reactive protein in the diagnosis of neonatal sepsis keeping blood cultures as gold standard. Study Design: Descriptive cross-sectional study. Setting: Pediatric Unit of Lady Reading Hospital Peshawar Pakistan. Duration: Six months from 09-06-2012 to 08-12-2012. Methodology: Total of 196 patients meeting the required inclusion criteria with clinical suspicion of sepsis. Those neonates were subjected to investigations. C.R.P. was tested using the Quantitative method according to the instructions provided with the kit. By keeping blood culture as gold standard, patients with both positive and negative cultures were taken and the results compared to the results of C.R.P. in these subjects being positive or negative. Results: Among the 196, majority of the neonates included were less than a week old having a mean age of 4.5 days. There were 57 (29%) females and 139 (71%) males, with male to female ratio of 2.4:1. Blood cultures were positive in 85 (43%) and negative in 111 (57%) cases, while C.R.P. was positive in 95 (48%) and negative in 101 (52%) cases. Sensitivity, specificity, and positive and predictive values of C-reactive protein were calculated using formulas, and they turned out to be 77.6%, 73.8%, 69.4%, and 81.2% respectively with accuracy being 0.41%. Conclusion: An accurate and timely diagnosis of early onset neonatal sepsis remains challenging to the clinician as well as laboratory. Physicians can prevent unnecessary antibiotic use by performing the qualitative estimation CRP as a single, rapid and inexpensive test with a negative predictive value of 81.2%.

Should They Stay or Should They Go? The Utility of C-Reactive Protein in Predicting Readmission and Anastomotic Leak After Colorectal Resection.

Hospital readmission and anastomotic leak following colorectal resection have a negative impact on patients, surgeons, and the health care system. Novel markers of patients unlikely to experience these complications are of value in avoiding readmission. This study aimed to determine the predictive value of C-reactive protein for readmission and anastomotic leak within 30 days following colorectal resection. This is a retrospective review of a prospectively compiled single-institution database. From January 1, 2013, to July 20, 2017, consecutive patients undergoing elective colorectal resection with anastomosis without the presence of proximal intestinal stoma, who had C-reactive protein measured on postoperative day 3, were included. The primary outcome measured was the predictive value of C-reactive protein measured on postoperative day 3 for readmission or anastomotic leak within 30 days after colorectal resection. Of the 752 patients examined, 73 (10%) were readmitted within 30 days of surgery and 17 (2%) had an anastomotic leak. Mean C-reactive protein in patients who neither had an anastomotic leak nor were readmitted (127 ± 77 mg/L) was lower than for patients who were readmitted (157 ± 96 mg/L, p = 0.002) and lower than for patients who had an anastomotic leak (228 ± 123 mg/L, p = 0.0000002). The area under the receiver operating characteristic curve for the diagnostic accuracy of C-reactive protein for readmission was 0.59, with a cutoff value of 145 mg/L, generating a 93% negative predictive value. The area under the curve for the diagnostic accuracy of C-reactive protein for anastomotic leak was 0.76, with a cutoff value of 147 mg/L generating a 99% negative predictive value. This study was limited by its retrospective design and because all patients were treated at a single center. Patients with a C-reactive protein below 145 mg/L on postoperative day 3 after colorectal resection have a low likelihood of readmission within 30 days, and a very low likelihood of anastomotic leak. See Video Abstract at http://links.lww.com/DCR/A761.