Negative Predictive Value Of C-reactive Protein Research Articles

C-Reactive Protein, Procalcitonin, and White Blood Count to Rule Out Neonatal Early-onset Sepsis Within 36 Hours: A Secondary Analysis of the Neonatal Procalcitonin Intervention Study.

Neonatal early-onset sepsis (EOS) is one of the main causes of global neonatal mortality and morbidity, and initiation of early antibiotic treatment is key. However, antibiotics may be harmful. We performed a secondary analysis of results from the Neonatal Procalcitonin Intervention Study, a prospective, multicenter, randomized, controlled intervention study. The primary outcome was the diagnostic accuracy of serial measurements of C-reactive protein (CRP), procalcitonin (PCT), and white blood count (WBC) within different time windows to rule out culture-positive EOS (proven sepsis). We analyzed 1678 neonates with 10 899 biomarker measurements (4654 CRP, 2047 PCT, and 4198 WBC) obtained within the first 48 hours after the start of antibiotic therapy due to suspected EOS. The areas under the curve (AUC) comparing no sepsis vs proven sepsis for maximum values of CRP, PCT, and WBC within 36 hours were 0.986, 0.921, and 0.360, respectively. The AUCs for CRP and PCT increased with extended time frames up to 36 hours, but there was no further difference between start to 36 hours vs start to 48 hours. Cutoff values at 16 mg/L for CRP and 2.8 ng/L for PCT provided a sensitivity of 100% for discriminating no sepsis vs proven sepsis. Normal serial CRP and PCT measurements within 36 hours after the start of empiric antibiotic therapy can exclude the presence of neonatal EOS with a high probability. The negative predictive values of CRP and PCT do not increase after 36 hours.

Utility of hematological parameters and C-reactive protein levels in early diagnosis of neonatal sepsis

Objective: The objective of the study is to determine the utility of hematological parameters and C-reactive protein (CRP) levels as diagnostic markers in the early diagnosis of Neonatal Sepsis. Materials and Methods: Study area: Neonatal intensive care unit at KLE's Dr. Prabhakar Kore Hospital, Belagavi. Study design: A cross-sectional study. Study period: January 2017–December 2017 over a period of 1 year. Study participants: Neonates with signs suggestive of sepsis admitted to Neonatal intensive care unit at KLE's Dr. Prabhakar Kore Hospital, Belagavi. Sample Size: 34. Sampling procedure: Universal sampling method. Results: Considering blood culture as gold standard, sensitivity of hemoglobin levels was 35.2%, specificity was 57.6%, positive predictive value was 50%, and negative predictive value was 57.6%. P = 0.659, which was statistically insignificant. Sensitivity of altered white blood cell count was 47.65%, specificity was 53.8%, positive predictive value was 62.5%, negative predictive value of 38.8% and P = 0.933 which was statistically insignificant. Sensitivity of altered platelet count was 38%, specificity was 69.2%, positive predictive value was 66.6%, negative predictive value of 59% and P = 0.664 which was statistically insignificant. Sensitivity of elevated CRP levels was 57.1%, specificity was 92.3%, positive predictive value was 92.3%, negative predictive value of 57.1%, and P = 0.0039 which was statistically significant. Conclusion: Higher sensitivity and negative predictive value of CRP compared to hematological parameters makes it a better diagnostic marker in the early diagnosis of neonatal sepsis.

The usefulness of C-reactive protein in predicting malaria parasitemia in a sub-Saharan African region.

BackgroundMalaria remains a leading cause of childhood mortality in sub-Saharan Africa. Identifying patients who are at risk for severe manifestations at presentation still remains challenging. This study examines whether a semi-quantitative test on C-Reactive Protein (CRP) could be useful for rapidly predicting the presence or absence of malarial parasitemia in febrile children.MethodData were collected from children with fever or a history of fever at the Agogo Presbyterian Hospital in the Ashanti Region of Ghana. Haematological measurements, microscopic detection of plasmodium species and semi-quantitative CRP measurements with a membrane–based immunoassay for whole blood were performed. CRP was classified as positive when the measured level was ≥ 10 mg/l.ResultsDuring 548 visits, thick blood film results could be obtained from 541 patients, 270 (49.3%) yielded parasitemia with Plasmodium spp. Whereas malaria parasites were detected in only a few patients (7.1%) with normal CRP levels (< 10mg/l), more than a half of patients with an increased CRP concentration (≥ 10 mg/l) were parasite positive (OR 14.5 [CI 4.4–47.6], p<0.001). Patients with increased CRP levels had more than an eight-fold likelihood for parasitemia after correction for other parameters (adjusted OR 8.7 [CI 2.5–30.5], p<0.001). Sensitivity, specificity as well as positive predictive and negative predictive values of CRP for malaria were 99.3% (CI 96.2%-100%), 9.2% (CI 6.4%-12.8%), 31.7% (CI 27.4%-36.1%) and 97.0% (CI 84.2%-99.9%), respectively.ConclusionThe semi-quantitative method of measuring CRP is cheap, rapid and easy to perform but not useful in predicting parasitemia and malaria. However, due to its high negative predictive value, it could have a role in identifying those patients unlikely to be presenting with clinical malaria.

Diagnostic Significance of White Blood Cell Count and C-Reactive Protein in Neonatal Sepsis; Asella Referral Hospital, South East Ethiopia.

Introduction:Nowadays various biochemical markers, such as C-Reactive Protein (CRP), Procalcitonin and tumor necrosis factor alpha, have been proposed as a potential marker for screening neonatal sepsis. In the current study, we tried to see the diagnostic significance of White Blood Cell (WBC) count and CRP in diagnostic screening of neonatal sepsis.Methods:A prospective cross-sectional study was conducted from May 2016 to April 2017 in Asella Teaching and Referral Hospital. Data were entered into EPI-INFO version 3.5.1 for cleanup and then exported to SPSS version 17 for further analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were used to assess the accuracy of CRP and WBC count taking blood culture as gold standard.Results:Data of 303 neonates with clinical sepsis were analyzed. Positive CRP and abnormal WBC were reported in 136(45%) and 99(32.7%) of study subjects respectively. Blood culture turned to be positive in 88(29.4%) of study subjects. The Sensitivity, Specificity, PPV and NPV of WBC count were 59.5 %, 79.6%, 52%, 64.5% respectively while the sensitivity, specificity, PPV and NPV of CRP were 65.6%, 78%, 42% and 91% respectively. By combining both WBC and CRP, the sensitivity, specificity, PPV and NPV improve to 78.5%, 83%, 60% and 93% respectively. CRP positivity rate was comparable across gram positive and gram negative bacteria while high WBC count were more reported among gram positive sepsis than gram negative ( OR 4.8, (95% CI 1.45-15.87, P 0.01)Conclusion:Based on this study’s finding, it can be concluded that CRP alone or in combination with WBC count showed better diagnostic accuracy in neonatal sepsis.

Study of C - reactive protein in neonatal sepsis

Background: Sepsis is one of the most common causes of morbidity and mortality in the newborn. Early diagnosis and treatment is vital to improve outcome. Neonatal sepsis in newborn is characterized by paucity of signs and symptoms and is due to invasion and spread through the body of non-pathogenic/ pathogenic &amp; Gram positive / negative organism. It is subtle disease, the general characteristic of bacterial infection in neonatal period are influenced more by response of the infant than the causative organism. The present study was therefore carried out to determine the usefulness of C-reactive protein (CRP) for evaluation of neonatal sepsis in tertiary care hospital.Methods: Neonates with clinical suspicion of sepsis were prospectively studied out from June 2006 to January 2008. Blood was obtained from each subject recruited for the qualitative estimation of CRP. Blood culture was used as gold standard for diagnosis of NNS.Results: Of 50 neonates studied, 34 (68%) had positive CRP while 31 (62%) had positive blood culture. The sensitivity, specificity, positive and negative predictive values of CRP were 90.32%, 42.10%, 71.79% and 72.72% respectively.Conclusions: The qualitative method of estimating CRP which is cheap and rapid has moderate sensitivity, specificity and negative predictive value.

Validation of serum C-reactive protein for the diagnosis and monitoring of antibiotic therapy in neonatal sepsis.

Objective:To evaluate the adequacy of serum C-reactive protein (CRP) in diagnosing neonatal sepsis and role of CRP in determining the duration of antibiotic treatment in neonatal sepsis.Methods:In this validation study, we included 135 neonates with suspected diagnosis of sepsis within duration of nine months from September 2016 to May2017 in Children Hospital Multan. Blood samples were drawn from every neonate for culture sensitivity and measurement of serum C-reactive proteins. In all suspected neonates, empirical antibiotics e.g. Gentamycin or Ampicillin were started after taking blood samples. Serum CRP levels >5 mg/dl were marked as positive results. 2nd blood samples for measurement of serum CRP were taken after 72 hours of the first sample. There were two primary endpoints; one to determine the sensitivity and specificity of CRP against blood culture and second was to determine the negative predictive value of CRP in determining the duration of anti-biotic in neonates presenting with sepsis.Results:Out of these 135 babies, 102 (75.5%) were confirmed to have sepsis using blood culture reports. CRP results were Positive in 85 (62.9%) neonates on first baseline measurement and were positive in 103 (76.29%) neonates after 72 hours of admission. The sensitivity of CRP in diagnosing sepsis was 98.03%, specificity was 91.0%, positive predictive value (PPV) was 97% and negative predictive value (NPV) was 93.7%. The mean duration of antibiotic treatment in CRP guided group was 5.03 days versus 7.02 days in standard treatment duration group (p-value <0.001). The NPV of CRP in determining the duration of antibiotics was 100.0%.Conclusion:Serum CRP level is a reliable test in establishing the diagnosis of neonatal sepsis. It accurately monitors the duration of antibiotic therapy and results in significant reduction in the treatment duration of neonatal sepsis.

Predictive value of procalcitonin or c-reactive protein for subclinical intrauterine infection in patients with premature rupture of membranes (PROM).

to evaluate the diagnostic value of procalcitonin (PCT) and C-reactive protein (CRP) for the prediction of subclinical intrauterine infection in patients with premature rupture of membranes (PROM). a retrospective analysis was performed based on patients with PROM admitted into our hospital between January 2011 and January 2016. Using the pathological diagnosis of placenta as the gold standard, the sensitivities, specificities, positive predictive values, and negative predictive values of PCT and CRP for the diagnosis of subclinical intrauterine infection at different gestational weeks were analyzed. Further, the diagnostic accuracies were compared according to their receiver operating characteristic (ROC) curves. 276 cases were included. The area under the ROC curve of CRP is 0.632, and it is significantly better than PCT. The sensitivity, specificity, positive predictive value, and negative predictive value of CRP are 0.686, 0.958, 0.501, and 0.765, which are all better than those of PCT. The group analysis according to different gestational weeks demonstrated that for the group of 28-33+6 weeks pregnant women, the area under the ROC curve of CRP and PCT is 0.869, and 0.787. The both test have satisfactory accuracy. But the sensitivity and specificity of PCT is 0.830, and 0.950, respectively. That are significantly better than CRP. both PCT and CRP have good application potential for the diagnostic prediction of subclinical intrauterine infection in <34 gestational weeks pregnant women with PROM, and PCT is more applicable to 28-33+6 gestational weeks pregnant women with PROM.

Predictive values of serum amyloid-A and CRP for infection in febrile neutropenic cancer patients

Objectives: To evaluate predictive values of serum amyloid A (SAA) and C-reactive protein (CRP) for infection and mortality in patients with febrile neutropenia (FEN). Methods: Daily measurement of serum SAA and CRP levels of patients during antibiotherapy for FEN. Results: Sixty-five FEN episodes of 52 patients were evaluated. Median CRP and SAA levels on 1st day of FEN were 137 mg/L (23-420 mg/L) and 547 mg/L (11-1660 mg/L), respectively. For detection of infection of infection the sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of SAA at a level of >80 mg/L were as 100%, 48% and 100%. Whilethe sensitivity, PPV, and NPV of CRP at a level of >50mg/L were as 86%, 47% and 60%, respectively. Predictive values of initial SAA and CRP levels for infection didn’t differ significantly (CRP: p=0.24, SAA: p=0.39). SAA and CRP levels on the last day of FEN course were significant for infection and mortality (for infection: p=0.003 for CRP and p=0.026 for SAA; for mortality: p<0.001 for CRP and p=0.021 for SAA). Both initial and daily SAA and CRP levels correlated with each other positively and statistically significantly (p<0.001). The area under the curve (AUC) on the re ceiver operating character (ROC) curve for CRP and SAA were 0.72 (p=0.003, 95% CI: 0.59-0.86) and 0.68 (p=0.19, 95% CI: 0.54-0.82), respectively. Conclusions: Despite low predictive values in decision of initial therapy, these parameters would be helpful in decision of modification and evaluation of response to therapy. J Microbiol Infect Dis 2014; 4(4): 128-135

Elevation of CRP Precedes Bloodstream Infections in Patients Undergoing Hematopoietic Cell Transplantation – a Case-Control Study.

AbstractAbstract 3026Infectious complications remain a major cause of morbidity and mortality following aggressive chemotherapy or hematopoietic cell transplantation. Early appropriate treatment decreases mortality. C-reactive protein (CRP) is a biomarker of infections, however data whether CRP can help in early detection of infections in patients undergoing hematopoietic cell transplantation are scarce.We aimed to prospectively examine whether CRP elevation precedes the clinical signs and symptoms of sepsis in HCT recipients with bloodstream infections (BSIs). In all patients in the hematopoietic cell transplantation ward, CRP blood levels were measured once daily. Cases were defined as patients with clinically-significant BSI (bacteremia or fungemia). Controls were defined as afebrile patients without a suspected or document infection. Cohorts were matched by the type of transplantation, time from transplantation, GVHD status and age. We calculated the mean difference (MD) between the CRP on day -1 (1 day before clinical suspicion of infection) and days -2 and -3 (deltaM1M2 and delta M1M3, respectively). We compared these delta values between cases and controls. Using the delta M1M value observed in our case-control study, we examined the sensitivity, specificity, positive and negative predictive values of this difference in CRP between consecutive days for diagnosis of BSIs among all admitted patients.From January 2010 to April 2012 we identified 50 cases of BSI (gram negative, n=32; gram positive, n=15 and yeasts, n=3). Median days from HCT to BSI onset was 78 (range, (−2) – 232). 46 episodes (92%) occurred in patients receiving allografts and among these patients, in 39 patients (85%), episodes were preceded by graft vs. host disease. Delta M1M3 and delta M1M2 were significantly higher in patients with BSI compared to controls (MD=4.47, 95% CI 2.2–6.7, p<.001 and MD=3.7, 95% CI 1.99–5.4, p<.001, respectively). Only a trend for increased delta CRP was observed between days -2 and -3 (MD=1.4, 95% CI 0.9–2.9, p=.07). In the overall cohort, sensitivity and specificity of a daily delta value >4 were 52% and 98%, respectively. The positive and negative predictive values were 66% and 98%, respectively. Other etiologies that were associated with a daily increase in CRP >4 were non-bacteremic infections, infusion reactions associated with administration of anti-thymocytes globulin, engraftment and the onset of graft vs. host disease.We conclude that CRP has a valuable role in the sequential monitoring of patients undergoing hematopoietic cell transplantation and might serve as an early predictor for infectious episodes. The high negative predictive value of CRP in decision analysis regarding empiric antibiotic treatment in cases of fever should be further studied. Increase CRP blood levels in afebrile HCT recipients should raise the suspicion for infectious etiology. Disclosures:No relevant conflicts of interest to declare.

Prospective evaluation of the usefulness of C-reactive protein in the diagnosis of neonatal sepsis in a sub-Saharan African region

BackgroundSepsis is one of the most common causes of morbidity and mortality in the newborn. Early diagnosis and treatment is vital to improve outcome. The present study was therefore carried out to determine the usefulness of C-reactive protein (CRP) for evaluation of neonatal sepsis in Port Harcourt, Nigeria in Sub-Saharan Africa.MethodFour hundred and twenty neonates with clinical suspicion of sepsis were prospectively studied over a 6 month period. Blood was obtained from each subject recruited for the qualitative estimation of CRP. Blood culture was used as gold standard for diagnosis of NNS.ResultsOf 420 neonates studied, 196 (46.7%) had positive CRP while 181 (43.1%) had positive blood culture. The sensitivity, specificity, positive and negative predictive values of CRP were 74.0%, 74.1%, 68.4% and 79.0% respectively.ConclusionThe qualitative method of estimating CRP which is cheap and rapid has moderate sensitivity, specificity and negative predictive value.

Significance of high sensitivity C-reactive protein and D-dimer in evaluating intracardiac thrombus and spontaneous echo contrast in patients referred for transesophageal echocardiography: A prospective study

Intra-cardiac thrombus (ICT) and spontaneous echo contrast (SEC) are considered hypercoagulable and inflammatory conditions. We aimed to determine if high sensitivity C-reactive protein (CRP) and D-dimer (DD), in combination with variables of lower thrombotic risk (normal ejection fraction [NEF], sinus rhythm [NSR]), may predict the absence of ICT/SEC. Consecutive patients referred for transesophageal echocardiogram (TEE) for evaluation of cardioembolic source were prospectively enrolled. CRP and DD levels were determined at the time of TEE. 124 patients were enrolled, of whom 21 had ICT/SEC. The combination of NSR/NEF had a negative predictive value (NPV) of 98.6% for absence of ICT/SEC. The NPVs of CRP and DD were 93.6% and 85%, respectively. Adding either CRP or DD to NSR/NEF combination increased the NPV to 100%. Log CRP was significantly associated with ICT/SEC. The presence of NSR and NEF may defer the need for TEE for ICT/SEC evaluation. CRP association with ICT/SEC suggests that inflammation plays a role in ICT/SEC formation. Whether CRP and DD should become routine in the triage process of TEE for ICT/SEC evaluation requires further large scale prospective studies.

C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection

C-reactive protein (CRP) may be useful in predicting postoperative complications [1]. We investigated the sensitivity and specificity of postoperative CRP for infective complications after elective colorectal surgery. One hundred and sixty consecutive patients (72 years old; interquartile range, 63-79) undergoing elective resection for colorectal cancer treated between September 2003 and October 2006 were studied. Details of the postoperative course were prospectively entered into a database. Of the 160 patients, 10 had incomplete CRP data and were excluded from further analysis. Infective complications occurred in 21%, with an overall complication rate of 29%. Infective complications occurred as follows: respiratory (10), wound (9), urinary tract (2) and central line infection (1), anastomotic leakage (5), intra-abdominal abscess (3) and septicaemia of unknown origin (2). There were three postoperative deaths. The positive predictive value for infection of CRP > 145 mg/l on postoperative day 4 was 61%. The negative predictive value of CRP < 145 mg/l on postoperative day 4 for an infective complication was 96%. A CRP > 145 mg/l on day 4 has high specificity and sensitivity for infective complications following elective colorectal resection.

Acute phase proteins and white blood cell levels for prediction of infectious complications in status epilepticus

IntroductionInfections in status epilepticus (SE) patients result in severe morbidity making early diagnosis crucial. As SE may lead to inflammatory reaction, the value of acute phase proteins and white blood cells (WBC) for diagnosis of infections during SE may be important. We examined the reliability of C-reactive protein (CRP), procalcitonin (PCT), and WBC for diagnosis of infections during SE.MethodsAll consecutive SE patients treated in the ICU from 2005 to 2009 were included. Clinical and microbiological records, and measurements of CRP and WBC during SE were analyzed. Subgroup analysis was performed for additional PCT measurements in the first 48 hours of SE.ResultsA total of 22.5% of 160 consecutive SE patients had infections during SE. Single levels of CRP and WBC had no association with the presence of infections. Their linear changes over the first three days after SE onset were significantly associated with the presence of infections (P = 0.0012 for CRP, P = 0.0137 for WBC). Levels of PCT were available for 31 patients and did not differ significantly in patients with and without infections. Sensitivity of PCT and CRP was high (94% and 83%) and the negative predictive value of CRP increased over the first three days to 97%. Specificity was low, without improvement for different cut-offs.ConclusionsSingle levels of CRP and WBC are not reliable for diagnosis of infections during SE, while their linear changes over time significantly correlate with the presence of infections. In addition, low levels of CRP and PCT rule out hospital-acquired infections in SE patients.

Diagnostic audit of C-reactive protein in neonatal infection

A prospective study of 250 consecutive neonatal admissions to a regional perinatal referral centre and of 10 additional consecutive cases with culture-proven neonatal septicaemia was undertaken. Quantitative C-reactive protein (CRP) determination, white cell count and differential were performed on blood samples obtained from all babies on admission, as well as 10-14 h and 22-26 h later. Using clinical signs, chest X-rays, blood cultures, tracheal aspirates obtained within 4 h of delivery and an abnormal immature/total neutrophil ratio (I/T), infected babies were defined as belonging to one of the following groups: culture-proven septicaemia (n = 19); clinical septicaemia (n = 35); congenital pneumonia (n = 28). The sensitivity, specificity, positive and negative predictive value of CRP were calculated for each sampling time and patient group. No baby had a rise in CRP (greater than 6 mg/l) before an abnormal I/T ratio was first detected. A delayed rise in CRP concentration in the majority of infected babies occurred approximately 12-24 h after the abnormal I/T ratio was first detected. The overall specificity of a CRP level of greater than or equal to 10 mg/l remained approximately constant (97%-94%) while sensitivity increased from 22%-61% with increasing time after admission. The same pattern emerged if each patient group was considered separately. The positive predictive value for a CRP level of greater than or equal to 10 mg/l 22-26 h after admission was 83% and the negative predictive value 82%. CRP had no value in the early diagnosis of neonatal infection. Its main role lies rather in the exclusion or confirmation of infection 24 h after the first clinical suspicion.