Predictive Value Of C-reactive Protein Research Articles

Predictive value of C-reactive protein for postoperative liver-specific surgical site infections

BackgroundC-reactive protein is a useful biological tool to predict infectious complications, but its predictive value in detecting organ-specific surgical site infection after liver resection has never been studied. We aimed to evaluate the predictive value of c-reactive protein and determine the cut-off values to detect postoperative liver resection–surgical site infection. MethodsA multicentric analysis of consecutive patients with liver resection between 2018 and 2021 was performed. The predictive value of postoperative day 1, postoperative day 3, and postoperative day 5 C-reactive protein levels was evaluated using the area under the receiver operating characteristic curve. Cut-off values were determined using the Youden index in a 500-fold bootstrap resampling of 500 patients treated at 3 centers, who comprised the development cohort and were tested in an external independent validation cohort of 166 patients at a fourth center. ResultsAmong the 500 patients who underwent liver resection of the development cohort, liver resection–surgical site infection occurred in 66 patients (13.2%), and the median time to diagnosis was 6.0 days (interquartile range, 4.0–9.0) days. Median C-reactive protein levels were significantly higher on postoperative day 1, postoperative day 3, and postoperative day 5 in the liver resection–surgical site infection group compared with the non–surgical site infection group (50.5 vs 34.5 ng/mL, 148.0 vs 72.5 ng/mL, and 128.4 vs 35.2 ng/mL, respectively; P < .001). Postoperative day 3 and postoperative day 5 C-reactive protein–level area under the curve values were 0.76 (95% confidence interval, 0.64–0.88, P < .001) and 0.82 (95% confidence interval, 0.72–0.92, P < .001), respectively. Postoperative day 3 and postoperative day 5 optimal cut-off values of 100 mg/L and 87.0 mg/L could be used to rule out liver resection–surgical site infection, with a negative predictive value of 87.0% (interquartile range, 70.2–93.8) and 76.0% (interquartile range, 65.0–88.0), respectively, in the validation cohort. ConclusionPostoperative day 3 and postoperative day 5 C-reactive protein levels may be valuable predictive tools for liver resection–surgical site infection and aid in hospital discharge decision-making in the absence of other liver-related complications.

Persistently High Procalcitonin and C-Reactive Protein Are Good Predictors of Infection in Acute Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis.

Infected necrotizing pancreatitis (INP) is associated with an increased risk of organ failure and mortality. Its early recognition and timely initiation of antibiotic therapy can save patients' lives. We systematically searched three databases on 27 October 2022. In the eligible studies, the presence of infection in necrotizing pancreatitis was confirmed via a reference test, which involved either the identification of gas within the necrotic collection through computed tomography imaging or the examination of collected samples, which yielded positive results in Gram staining or culture. Laboratory biomarkers compared between sterile necrotizing pancreatitis and INP were used as the index test, and our outcome measures included sensitivity, specificity, the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Within the first 72 hours (h) after admission, the AUC of C-reactive protein (CRP) was 0.69 (confidence interval (CI): 0.62-0.76), for procalcitonin (PCT), it was 0.69 (CI: 0.60-0.78), and for white blood cell count, it was 0.61 (CI: 0.47-0.75). After the first 72 h, the pooled AUC of CRP showed an elevated level of 0.88 (CI: 0.75-1.00), and for PCT, it was 0.86 (CI: 0.60-1.11). The predictive value of CRP and PCT for infection is poor within 72 h after hospital admission but seems good after the first 72 h. Based on these results, infection is likely in case of persistently high CRP and PCT, and antibiotic initiation may be recommended.

Predictive Value of C-Reactive Protein to Albumin Ratio for Amputation Risk in Diabetic Foot Infection.

Diabetic foot infections are one of the complications of diabetes mellitus resulting in extremity amputation and mortality. This study aimed to examine the predictive value of the C-reactive protein (CRP) to albumin ratio (CAR) for amputation risk in diabetic foot infection. Data from 178 patients were retrospectively examined. We found the cut point value of 15.45 according to the receiver operating characteristic (ROC) curve to show the predictive value of CAR for amputation risk in the overall population. We then divided the patients into two groups low (<15.45, n = 96) and high risk (≥15.45, n = 82) according to their CAR value. Matching based on propensity scores produced 64 patients in each group and showed that the amputation rate was high in the high-risk groups (50 vs 25%, P = .003). In the multivariate analysis in the matching group, previous amputation, antibiotic therapy in the last 3 months, and CAR (Odds ratio [OR]: 1.30, 95%Confidence interval [CI]: 1.01-1.45, P < .001) were independent predictors of amputation. These parameters may be useful to predict amputation risk in these patient groups.

Association of C-reactive protein level with adverse outcomes in patients with atrial fibrillation: A meta-analysis

BackgroundStudies on the association between C-reactive protein (CRP) level and poor outcomes have been yielded controversial results in patients with atrial fibrillation (AF). This meta-analysis sought to investigate the utility of elevated CRP level in predicting adverse outcomes in AF patients. MethodsTwo authors systematically searched PubMed and Embase databases (until December 10, 2022) for studies evaluating the value of elevated CRP level in predicting all-cause mortality, cardiovascular death, stroke, or major adverse cardiovascular events (MACEs) in AF patients. The predictive value of CRP was expressed by pooling adjusted hazard ratio (HR) with 95% confidence intervals (CI) for the highest versus the lowest level or per unit of log-transformed increase. ResultsTen studies including 30,345 AF patients satisfied our inclusion criteria. For the highest versus the lowest CRP level, the pooled adjusted HR was 1.57 (95% CI 1.34-1.85) for all-cause mortality, 1.18 (95% CI 0.92-1.50) for cardiovascular death, and 1.57 (95% CI 1.10-2.24) for stroke, respectively. When analyzed the CRP level as continuous data, per unit of log-transformed increase was associated with a 27% higher risk of all-cause mortality (HR 1.27; 95% CI 1.23-1.32) and 16% higher risk of MACEs (HR 1.16; 95% CI 1.05-1.28). ConclusionsElevated CRP level may be an independent predictor of all-cause mortality, stroke, and MACEs in patients with AF. CRP level at baseline can provide important prognostic information in risk classification of AF patients.

Predictive value of C-reactive protein, D-dimer, Hemoglobin and Lactate dehydrogenase levels in diagnosing COVID-19 patients

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused enormous issues worldwide and is the most infectious pandemic. 50 subjects (evenly distributed between sexes) were included in this study, as well as their range of ages starting from 2 to 67 years. According to the study's result, the age and gender of the subjects include susceptibility to COVID-19; males were found to be more infected than females, and the ages 36 to 67 were more common than in other age ranges. Also, BMI calculations revealed that male patients with COVID-19 had the highest percentage of obesity. The clinical parameter results have been found serum C‐reactive protein (CRP) as an essential indicator that changes significantly in infection with COVID‐19 and inflammation. The concentration of CRP is higher levels for positive COVID‐19 patients (male and female) with mild symptoms of COVID-19 than those with negative COVID‐19 infection, and CRP levels were found to be higher in male than female patients. The results of D-dimer levels determined a nonsignificant difference in D-dimer levels in COVID-19 patients and non-COVID-19 patients than the normal concentration (N: Less than 500mg/dl.). The results of hemoglobin blood levels demonstrated significant variations between COVID-19 patients and non-COVID-19 patients and a decrease in Hb concentration compared to normal concentration (N: 11-16 g/dl.); thus, a link between anemia and inflammation. The lactate dehydrogenase (LDH) levels increased in positive COVID-19 patients male were (178.79 ± 56.08) mg/dl, and positive COVID-19 patients female were (141.57 ± 46.90) mg/dl than normal (N: Less than100mg/dl.), and significant variation was observed between positive and negative COVID-19 patients. Keywords: COVID-19; C‐reactive protein; hemoglobin; lactate dehydrogenase.

632P Predictive value of C-reactive protein (CRP) in microsatellite-stable (MSS) metastatic colorectal cancer (mCRC) patients given first-line alternating short-course oxaliplatin-based chemotherapy (FLOX) and nivolumab

632P Predictive value of C-reactive protein (CRP) in microsatellite-stable (MSS) metastatic colorectal cancer (mCRC) patients given first-line alternating short-course oxaliplatin-based chemotherapy (FLOX) and nivolumab

Combining C-reactive protein, procalcitonin, and serum albumin to predict long-term mortality in patients with infective endocarditis.

To determine the predictive value of C-reactive protein (CRP) plus albumin plus procalcitonin for long-term mortality in patients with infective endocarditis. This retrospective study included patients hospitalized with infective endocarditis between February 2008 and December 2021. CRP, procalcitonin, and albumin levels were measured within 24 h of admission and dichotomized as high or low. A CRP plus procalcitonin plus albumin points system (range, 3-6) was generated based on high or low CRP, procalcitonin, and albumin concentrations. Patients were divided into two groups: low-risk (≤4 points) and high-risk (>4 points), according to total score. The primary outcome was defined as all-cause mortality rate at long-term follow-up. Out of 204 patients in total, the high-risk group (n = 29) had higher procalcitonin and CRP levels versus the low-risk group (n = 175), but lower albumin level versus the low-risk group (2.7 ± 0.5 versus 3.5 ± 0.6 g/dl). Matching based on propensity scores showed a higher mortality rate in high-risk versus low-risk patients (76% versus 44%, respectively). In multivariate analysis after matching, the high-risk group was associated with increased long-term mortality (adjusted hazard ratio 2.87, 95% confidence interval 1.32, 6.26).Conclusions: A high CRP plus albumin plus procalcitonin score was associated with long-term mortality risk in patients with infective endocarditis.

Predictive value of C-reactive protein, D-dimer, Hemoglobin and Lactate dehydrogenase levels in diagnosing COVID-19 patients

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused enormous issues worldwide and is the most infectious pandemic. This study included 50 subjects (evenly distributed between sexes) and their range of ages starting from 2 to 67 years. According to the study's result, the ages and genders of subjects include susceptibility to COVID-19. Males were found to be more infected than females, and the ages of 36 to 67 were more common than other age ranges. Also, BMI calculations revealed that male patients with COVID-19 have the highest percentage of obesity. The clinical parameter results have been found serum C‐reactive protein (CRP) as an essential indicator that changes significantly in infection with COVID‐19 and inflammation. The concentration of CRP is higher for positive COVID‐19 patients (male and female) with mild symptoms of COVID-19 than for harmful COVID‐19 infection, and CRP levels were higher in male than female patients. The results of D-dimer levels determined a non-significant difference in D-dimer levels in COVID-19 patients and non-COVID-19 patients than the average concentration (N: Less than 500mg/dl.). The results of hemoglobin blood levels demonstrated significant variations between COVID-19 and non-COVID-19 patients and a decreased Hb concentration compared to average concentration (N: 11-16 g/dl.); thus a link between anemia and inflammation. The lactate dehydrogenase (LDH) levels increased in positive COVID-19 patients male were (178.79 ± 56.08) mg/dl, and positive COVID-19 patients female were (141.57 ± 46.90) mg/dl than average (N: Less than100mg/dl.), and significant variation was observed between positive and negative COVID-19 patients. Keywords: COVID-19; C‐reactive protein; hemoglobin; lactate dehydrogenase.

The prognostic and predictive roles of plasma C-reactive protein and PD-L1 in non-small cell lung cancer.

Anti-PD-(L)1 agents have revolutionized the treatment paradigms of non-small cell lung cancer (NSCLC), while predictive biomarkers are limited. It has been previously shown that systemic inflammation, indicated by elevated C-reactive protein (CRP) level, is associated with a poor prognosis in anti-PD-(L)1 treated. The aim of the study was to analyze the prognostic and predictive value of CRP in addition to traditional prognostic and predictive markers and tumor PD-L1 score. We identified all NSCLC patients (n = 329) who had undergone PD-L1 tumor proportion score (TPS) analysis at Oulu University Hospital 2015-22. CRP levels, treatment history, immune checkpoint inhibitor (ICI) therapy details, and survival were collected. The patients were categorized based on CRP levels (≤10 vs. >10) and PD-L1 TPS scores (<50 vs. ≥50). In the whole cohort (n = 329), CRP level of ≤10 mg/L was associated with improved survival in univariate (HR 0.30, Cl 95% 0.22-0.41) and multivariate analyzes (HR 0.44, CI 95% 0.28-0.68). With ICI treated (n = 70), both CRP of ≤10 and PD-L1 TPS of ≥50 were associated with improved progression-free survival (PFS) in univariate (HR 0.51, CI 95% 0.27-0.96; HR 0.54, CI 95% 0.28-1.02) and multivariate (HR 0.48, CI 95% 0.26-0.90; HR 0.50, CI 95% 0.26-0.95) analyzes. The combination (PD-L1 TPS ≥50 and CRP >10) carried a high negative predictive value with a median PFS of 4.11 months (CI 95% 0.00-9.63), which was similar to patients with low PD-L1 (4.11 months, CI 95% 2.61-5.60). Adding plasma CRP levels to PD-L1 TPS significantly increased the predictive value of sole PD-L1. Furthermore, patients with high CRP beard little benefit from anti-PD-(L)1 therapies independent of PD-L1 score. The study highlights the combined evaluation of plasma CRP and PD-L1 TPS as a negative predictive marker for ICI therapies.

Predictive value of C-reactive protein, procalcitonin, and interleukin-6 on 30-day mortality in patients with bloodstream infections

BackgroundWe aimed to assess the predictive performance of C-reactive protein (hsCRP), procalcitonin (PCT), and interleukin-6 (IL-6) at different times points of bloodstream infections (BSI) management. MethodsThe cases were collected from January 2020 to June 2021 in the First Affiliated Hospital of Xinjiang Medical University (n=185). We collected patients’ records of hsCRP, PCT, and IL-6 serum levels and calculated the clearance of these biomarkers on day 1, day 3, and day 5 (hsCRP-1, hsCRP-3, hsCRP-5, so do PCT, and IL-6). We analyzed these predictive performances for 30-day mortality with ROC and Logistic regression. The correlation between biomarkers and their clearance rates was performed by a rank correlation method. ResultsThe 30-day mortality was 11.35% (21/185). Serial serum hsCRP-3, IL-6-3, PCT-1, PCT-3, and PCT-5 were statistically higher in BSI mortality than survivors. Significant predictive ability was found for 30-day mortality with blood culture (BC) reported fungi (OR, 0.033; 95% CI: 0.002–0.535) and PCT-5 (OR, 1.045; 95% CI: 1.013–1.078) levels, respectively. The AUC of PCT-5 levels for 30-day mortality was 0.784 (95% CI 0.678–0.949), and the cut-off value was 5.455ng/mL. ConclusionsPCT-5 is more valuable for the prognosis of 30-day mortality in patients with BSI compared to the other inflammatory biomarkers.

Predictive value of C-reactive protein-to-albumin ratio for risk of 28-day mortality in patients with severe pneumonia

Abstract Objectives To explore the predictive value of C-reactive protein (CRP)-to-albumin (ALB) ratio (CAR) for the risk of 28-day mortality in patients with severe pneumonia. Methods A total of 152 patients with severe pneumonia treated from January 2020 to January 2022 were enrolled and assigned into survival group (n=107) and death group (n=45) according to their survival status after treatment for 28 d. Their clinical data were compared, and the influencing factors for 28-day mortality were explored by multiple logistic regression analysis. The receiver operating characteristic (ROC) curve was plotted to assess the value of CAR for predicting 28-day mortality risk. A risk prediction model was constructed, and its prediction efficiency was evaluated. Results The death group had significantly older age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Murray Lung Injury Score, Sequential Organ Failure Assessment score, white blood cell count, neutrophil count, red cell volume distribution width, neutrophil-to-lymphocyte ratio (NLR), fibrinogen, procalcitonin, blood lactic acid (Lac), CRP and CAR and significantly lower oxygenation index and ALB than those of the survival group (p&lt;0.05). APACHE II score, NLR, Lac and CAR were independent risk factors for 28-day mortality (p&lt;0.05). AUC of the established prediction model was 0.826, with sensitivity of 88.45 % and specificity of 87.32 %, indicating high discrimination. The nomogram model had clinical value when the risk threshold probability was 11–93 %. Conclusions CAR is an independent risk factor that shows a high predictive value for the 28-day mortality risk in patients with severe pneumonia.

Prediction of coronary artery lesions based on C-reactive protein levels in children with Kawasaki Disease: a retrospective cohort study

ObjectiveSince coronary artery lesions (CALs) are the most severe complication of Kawasaki disease (KD), clinically speaking, early prediction of CALs is crucial. The authors aimed to investigate the predictive value of C-reactive protein (CRP) in predicting CALs in KD patients. MethodsKD patients were divided into the CALs group and the non-CALs group. The clinical and laboratory parameters were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of CALs. The receiver operating characteristic curve was applied to determine the optimal cut-off value. Results851 KD patients who met the inclusion criteria were studied, including 206 in the CALs group and 645 in the non-CALs group. Children in the CALs group had significantly higher CRP levels than the non-CALs group (p < 0.05). Multivariable logistic regression analysis showed that incomplete KD, male, lower hemoglobin, and higher CRP were independent risk factors for predicting CAL (all p < 0.05). The optimal cut-off value of initial serum CRP for predicting CALs was 105.5 mg/L, with a sensitivity of 47.57% and a specificity of 69.61%. In addition, KD patients with high CRP (≥105.5 mg/L) had a higher occurrence of CALs than those with low CRP (<105.5 mg/L) (33% vs 19%, p < 0.001). ConclusionThe incidence of CALs was significantly higher in patients with high CRP. CRP is an independent risk factor for CALs formation and may be useful for predicting CALs in KD patients.

Predictive value of C-reactive protein, procalcitonin, and interleukin-6 on 30-day mortality in patients with bloodstream infections

BackgroundWe aimed to assess the predictive performance of C-reactive protein (hsCRP), procalcitonin (PCT), and interleukin-6 (IL-6) at different times points of bloodstream infections (BSI) management. MethodsThe cases were collected from January 2020 to June 2021 in the First Affiliated Hospital of Xinjiang Medical University (n=185). We collected patients’ records of hsCRP, PCT, and IL-6 serum levels and calculated the clearance of these biomarkers on day 1, day 3, and day 5 (hsCRP-1, hsCRP-3, hsCRP-5, so do PCT, and IL-6). We analyzed these predictive performances for 30-day mortality with ROC and Logistic regression. The correlation between biomarkers and their clearance rates was performed by a rank correlation method. ResultsThe 30-day mortality was 11.35% (21/185). Serial serum hsCRP-3, IL-6-3, PCT-1, PCT-3, and PCT-5 were statistically higher in BSI mortality than survivors. Significant predictive ability was found for 30-day mortality with blood culture (BC) reported fungi (OR, 0.033; 95% CI: 0.002–0.535) and PCT-5 (OR, 1.045; 95% CI: 1.013–1.078) levels, respectively. The AUC of PCT-5 levels for 30-day mortality was 0.784 (95% CI 0.678–0.949), and the cut-off value was 5.455ng/mL. ConclusionsPCT-5 is more valuable for the prognosis of 30-day mortality in patients with BSI compared to the other inflammatory biomarkers.

Predictive value of the C-reactive protein/albumin ratio in severity and prognosis of acute pancreatitis.

To investigate the predictive value of C-reactive protein (CRP) to serum albumin (ALB) ratio in the severity and prognosis of acute pancreatitis (AP), and compare the predictive value of the CRP/ALB ratio with the Ranson score, modified computed tomography severity index (MCTSI) score, and Bedside Index of Severity in Acute Pancreatitis (BISAP) score. This cohort study retrospectively analyzed clinical data of AP patients from August 2018 to August 2020 in our hospital. Logistic regression analysis was utilized to determine the effects of CRP/ALB ratio, Ranson, MCTSI, and BISAP score on severe AP (SAP), pancreatic necrosis, organ failure, and death. The predictive values of CRP/ALB ratio, Ranson, MCTSI, and BISAP score were examined with the area under the curve (AUC) of the receiver operator characteristic (ROC) curve analysis. DeLong test was used to compare the AUCs between CRP/ALB ratio, Ranson, MCTSI, and BISAP score. Totally, 284 patients were included in this study, of which 35 AP patients (12.32%) developed SAP, 29 (10.21%) organ failure, 30 (10.56%) pancreatic necrosis and 11 (3.87%) died. The result revealed that CRP/ALB ratio on day 2 was associated with SAP [odds ratio (OR): 1.74, 95% confidence interval (CI): 1.32 to 2.29], death (OR: 1.73, 95%CI: 1.24 to 2.41), pancreatic necrosis (OR: 1.28, 95%CI: 1.08 to 1.50), and organ failure (OR: 1.43, 95%CI: 1.18 to 1.73) in AP patients. Similarly, CRP/ALB on day 3 was related to a higher risk of SAP (OR: 1.50, 95%CI: 1.24 to 1.81), death (OR: 1.8, 95%CI: 1.34 to 2.65), pancreatic necrosis (OR: 1.22, 95%CI: 1.04 to 1.42), and organ failure (OR: 1.21, 95%CI: 1.04 to 1.41). The predictive value of CRP/ALB ratio for pancreatic necrosis was lower than that of MCTSI, for organ failure was lower than that of Ranson and BISAP, and for death was higher than that of MCTSI. The CRP/ALB ratio may be a novel but promising, easily measurable, reproducible, non-invasive prognostic score that can be used to predict SAP, death, pancreatic necrosis, and organ failure in AP patients, which can be a supplement of Ranson, MCTSI, and BISAP scores.

Predictive Value of CRP, PCT and ESR on Piperacillin-Tazobactam in Treating Chronic Obstructive Pulmonary Disease with Pneumonia.

The goal of this paper was to investigate the predictive value on the efficacy of C-reactive protein (CRP), procalcitonin (PCT), and erythrocyte sedimentation rate (ESR) on piperacillin-tazobactam in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pneumonia. From January 2018 to May 2021, 52 AECOPD patients (AECOPD group) and 91 AECOPD patients with pneumonia (pneumonia group) were enrolled, and the levels of CRP, PCT, and ESR were compared. The pneumonia group was divided into a mild group and a severe group, and the correlation between the levels of CRP, PCT, and ESR and the severity of pneumonia was analyzed. The patients in the pneumonia group were treated with piperacillin and tazobactam, and the clinical efficacy of CRP, PCT, and ESR levels was analyzed. The pneumonia group, particularly the severe subtype, had higher CRP, PCT, and ESR than the AECOPD group. CRP, PCT, and ESR levels were related to the severity of pneumonia and were negatively associated with the efficacy of piperacillin and tazobactam. The AUC of the combined detection of CRP, PCT, and ESR levels was greater than 0.8 to evaluate the efficacy of piperacillin-tazobactam treatment. CRP ≥ 67.19 mg/L, PCT ≥ 1.73 ng/mL, and ESR ≥ 29.42 mm/hour were the related factors affecting the efficacy of piperacillin-tazobactam. CRP, PCT, and ESR levels are related to the severity of AECOPD complicated with pneumonia, and have value in evaluating the efficacy of piperacillin-tazobactam.

Predictive value of C-reactive protein for disease severity and survival in COVID-19 patients: a systematic review and meta-analysis.

Coronavirus disease 2019 (COVID-19) is an infectious disease that can develop multiple complications and even be life-threatening. The aim of this study is to summarize current evidence of C-reactive protein's (CRP) predictive value for disease severity and survival of COVID-19 patients, focusing on curing patients and reducing the risk of death. We systematically searched related studies from four large databases: Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Database, all published between December 2019 and June 2021. Then, we implemented meta-analysis using random-effects models through STATA 15.1 and Review Manager 5.3. We also implemented sensitivity analysis and used funnel plots to check publication bias. From the systematic search of the four databases, we were able to identify 18 studies containing a total of 3052 patients. Meta-analysis results showed that 1) CRP levels were lower in non-severe patients than in severe patients (Standardized Mean Difference (SMD) = - 0.87mg/L, 95% Confidence Interval (CI) = [ - 1.27, - 0.47], p < 0.001); 2) CRP levels were lower in non-intensive care unit (ICU) patients than in ICU patients (SMD = - 1.39mg/L, 95% CI = [- 1.68, - 1.11], p < 0.001), and 3) CRP levels were lower in survivors than in non-survivors (SMD =- 1.32mg/L, 95% CI = [- 1.95, - 0.69], p < 0.001). Sensitivity analysis showed these results were stable. Funnel plots indicated no publication bias. The CRP level may timely reflect disease severity and predict survival of COVID-19 patients and may be worthy of further popularization and application in clinic practice.

The predictive value of C-reactive protein to albümin ratio for ascending aort progression in patients with ascending aortic diameter of 40–50 mm

We aimed to investigate the ability of the C-reactive protein-to-albumin ratio (CAR) to predict ascending aorta progression in patients with 40–50 mm diameter of ascending aortic dilatation. A total of 182 diagnosed patients with ascending aortic diameters of 40–50 mm were enrolled in this study. The study population was divided into tertiles based on yearly ascending aortic growth rate values. Group I (n = 137) was defined as a value in the lower 2 tertiles (ascending aorta growth ≤ 1.00 mm/year), and group II (n = 45) was defined as a value in the third tertile (ascending aorta growth > 1.00 mm/year). Hypertension, chronic obstructive pulmonary disease, positive family history, and CAR were found to be independent risk factors for ascending aorta growth > 1.00 mm/year. The area under the ROC curve (AUC) of CAR was 0.771(95% CI 0.689–0.854) for predicting ascending aorta growth > 1.00 mm/year. In patients with 40–50 mm ascending aneurysms, CAR may be useful to predict ascending aorta progression.

Acute kidney injury in group A streptococcal bacteraemia: incidence, outcome and predictive value of C-reactive protein

Background A ubiquitous human pathogen, Streptococcus pyogenes (Group A Streptococcus, GAS) causes infections from mild pharyngitis to severe septic infections. Acute kidney injury (AKI) is a condition of prompt decline of renal function. The aim of the present study was to report the incidence and outcome of AKI in GAS bacteraemia and to evaluate the diagnostic value of serum C-reactive protein as an indicator of AKI. Methods All adult patients with GAS bacteraemia treated at Turku University Hospital from 2007 to 2018 were identified and their patient records were scrutinised. Results Of 195 included patients, 38 (19.5%) had AKI stage 1, 20 (10.3%) AKI stage 2 and 26 (13.3%) AKI stage 3 and 111 (56.9%) did not have AKI. The adjusted seven-day mortality was significantly higher in AKI stages 2 and 3 compared to the non-AKI group (15% and 19% vs. 3.6%; p = .046 and .006, respectively). Of the survivors, 95.8% met the criteria of renal recovery at discharge. The higher the AKI stage, the higher was the mean serum CRP level on admission. The optimal cut-off for CRP to identify patients with AKI stage 2 or 3 was ≥244 mg/l (sensitivity 82.6% and specificity 75.8%). Conclusions AKI is common in patients with GAS bacteraemia and the severity of AKI correlates with the CRP level on admission. The mortality of patients with GAS bacteraemia and AKI is significantly higher than of patients without AKI. Most survivors, however, show renal recovery. Key Message AKI is common in group A Streptococcal bacteraemia and increases mortality compared to bacteraemia alone. However, renal recovery is also common. A high CRP level on admission correlates significantly positively with the degree of severity of AKI.

C-reactive protein during the first 6 postoperative days after total hip arthroplasty cannot predict early periprosthetic infection

IntroductionPeriprosthetic joint infection (PJI) after total hip arthroplasty (THA) remains a serious complication in orthopaedic surgery. C-reactive protein (CRP) is widely used as a marker to screen for inflammatory complications. The early postoperative course is well known, but knowledge about the predictive value of CRP in the first 6 postoperative days for detecting an acute postoperative PJI is lacking.MethodsWe retrospectively analyzed the inpatient course of CRP of all primary THA and THA with acute PJI within 28 days in our hospital from 2013 to 2021. A receiver-operating curve (ROC) analysis was performed and the best CRP threshold for detecting an acute PJI based on Youden’s-index was calculated and an area-under-the curve (AUC) analysis of the threshold was performed.Results33 of 7042 patients included had an acute PJI within 28 days. Patients with acute PJI were older, had a higher BMI and longer operation time and suffered more often from diabetes mellitus. A preoperatively elevated CRP was a risk factor for PJI. CRP was significantly higher in the PJI group on postoperative days 3 and 5. Threshold values were calculated to be 152 mg/l on day 3 and 73 mg/l on day 5. However, these values had a low sensitivity (75%, 76%) and specificity (67%, 61%).ConclusionEspecially considering the decreasing length of stay after THA, the question of the usefulness of regular inpatient CRP checks arises. AUC analysis of the ROC showed a poor diagnostic accuracy in almost all cases. Only the dynamic analysis of the maximum CRP value to the lowest CRP value with a decrease of 102.7 mg/l showed a fair accuracy. This calls into question the clinical relevance of CRP in the first postoperative week for detection of acute postoperative PJI.

The Diagnostic Value of Various Inflammatory Biomarkers for Diagnosing Periprosthetic Joint Infection is Gender-Specific.

ObjectivePrevious studies have suggested that the diagnostic biomarkers of periprosthetic joint infection (PJI) are largely influenced by gender. In the present study, we aimed to evaluate the diagnostic value of traditional inflammatory biomarkers, fibrinolytic biomarkers (fibrinogen and D-dimer), and C-reactive protein (CRP)/albumin for PJI in different genders.MethodsA single-center retrospective analysis was performed on revision total hip or knee arthroplasty between June 2013 to June 2021, and the study included 80 patients in the PJI group and 136 patients in the non-PJI group. PJI was diagnosed based on the International Consensus Meeting (ICM) in 2018. The levels of CRP, fibrinogen, erythrocyte sedimentation rate (ESR), D-dimer, and albumin count were determined. Receiver operating characteristic (ROC) curves and Youden’s index were used to evaluate the diagnostic ability of various biomarkers.ResultsThe levels of CRP, fibrinogen, D-dimer, ESR, and CRP/albumin were significantly higher in the PJI group (P < 0.001). In PJI of females, the predictive value of CRP was the highest among the five biomarkers, with the area under the curve (AUC) of 0.98. The optimal predictive cut-off for CRP was 8.86 mg/L, with a sensitivity and specificity of 90.2% and 95.7%, respectively. When combined with the other four biomarkers, the AUC of CRP was 0.98, 0.99, 0.98, and 0.99, respectively. In PJI of males, the predictive value of ESR was the highest among the five biomarkers, with an AUC of 0.92. The optimal predictive cut-off for ESR was 14.50 mm/h, with a sensitivity and specificity of 84.6% and 86.6%, respectively. When combined with the other four biomarkers, the AUC of ESR was 0.95, 0.94, 0.93, and 0.97, respectively.ConclusionCRP and ESR were excellent biomarkers for diagnosing PJI in female and male patients, respectively, and their combined use with CPR/albumin could provide higher diagnostic value in different genders.