Specificity Of C-reactive Protein Research Articles

Improved diagnostic markers for invasive pulmonary aspergillosis in COPD patients.

The prevalence of invasive pulmonary aspergillosis (IPA) among patients with chronic obstructive pulmonary disease (COPD) is steadily increasing, leading to high mortality. Although early diagnosis can significantly reduce mortality, the efficacy of current diagnostic methods is limited. Consequently, there is a need for novel approaches for early IPA detection. This retrospective study involved 383 hospitalized COPD patients with GOLD stages III and IV. The IPA group (67 patients) and non-IPA group (316 patients) were identified at the First Affiliated Hospital of Guangzhou Medical University between January 2016 and February 2022. We analyzed common serological indicators in our hospital to identify predictive indicators for the early diagnosis of IPA in COPD patients. The sensitivity and specificity of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), lactate dehydrogenase (LDH), and ceruloplasmin (CER) for diagnosing IPA in COPD patients were as follows: CRP (91.2%, 57.7%), ESR (77.5%, 73.0%), PCT (60.5%, 71.4%), LDH (50.0%, 88.8%), and CER (60.7%, 74.3%). Combinations of biomarkers, such as CRP-ESR, CRP-LDH, ESR-LDH, ESR-CER, and LDH-CER, showed promising diagnostic potential, with larger area under the curve (AUC) values for IPA diagnosis in COPD patients. However, no statistically significant difference was observed between the diagnostic efficacy of single biomarkers and combined biomarkers. Notably, compared to those in the unassisted ventilation group, the patients in the assisted ventilation group (including noninvasive ventilation and tracheal intubation/incision-assisted ventilation group) exhibited significantly greater PCT and LDH levels, while the CER significantly decreased (p=0.021). There were no significant differences in biomarker levels between the ICU group and the non-ICU group. CRP (p<0.01), ESR (p=0.028), PCT (p<0.01), and CER (p<0.01) were positively correlated with hospitalization duration, whereas LDH was not correlated with hospitalization duration. Our study highlights the diagnostic potential of CRP, ESR, PCT, LDH, and CER for IPA in COPD patients. CRP and LDH can also initially predict the need for assisted ventilation, while CRP can initially estimate the length of hospitalization. This study represents the first report of the potential of CER for diagnosing IPA, suggesting its significance for further research.

Accuracy of C-Reactive Protein for Tuberculosis Detection in General-Population Screening and Ambulatory-Care Triage in Uganda.

Rationale: C-reactive protein (CRP) has demonstrated utility as a point-of-care triage test for tuberculosis (TB) in clinical settings, particularly among people with human immunodeficiency virus (HIV), but its performance for general-population TB screening is not well characterized. Objective: To assess the accuracy of CRP for detecting pulmonary TB disease among individuals undergoing community-based screening or presenting for evaluation of TB symptoms in Kampala, Uganda. Methods: We pooled data from two case-control studies conducted between May 2018 and December 2022 among adolescents and adults (⩾15 yr) in Kampala, Uganda. We conducted community-based screening for TB, regardless of symptoms. We enrolled people with Xpert MTB/RIF Ultra-positive (including trace) sputum results and a sample of people with Ultra-negative results. We also enrolled symptomatic patients diagnosed with TB and controls with negative TB evaluations from ambulatory care settings. Participants underwent further evaluation, including sputum culture, CRP, and HIV testing. We assessed the accuracy of CRP alone or with symptom screening against a bacteriologic reference standard. Our primary analysis evaluated the sensitivity and specificity of CRP at a cutoff of 5 mg/L. Diagnostic performance was summarized by calculating the area under the receiver operating curve (AUC). Results: In the community setting (n = 544), CRP ⩾ 5 mg/L had a sensitivity of 55.3% (95% confidence interval, 47.0-63.4%) and specificity of 84.7% (79.7-88.8%) for confirmed TB; AUC was 0.75 (0.70-0.79). Screening for CRP ⩾ 5 mg/L or positive symptoms increased sensitivity to 92.0% (86.4-95.8%) at the expense of specificity (57.1% [50.8-63.2%]). In the ambulatory care setting (n = 944), sensitivity of CRP ⩾ 5 mg/L was 86.7% (81.8-90.7%), specificity was 68.6% (64.8-72.2%), and AUC (0.84 [0.81-0.87]) did not differ significantly by HIV status. CRP ⩾ 5 mg/L was >90% sensitive among individuals with a medium or high semiquantitative Xpert result in both settings. Conclusions: Although CRP did not meet World Health Organization (WHO) TB screening benchmarks in the community, it demonstrated high specificity, and sensitivity was high among individuals with high sputum bacillary burden who are likely to be most infectious. In ambulatory care, estimated sensitivity and specificity were each within 4 percentage points of WHO benchmarks, with no meaningful difference in performance by HIV status.

De Ritis score as an inflammatory marker in Hashimoto's thyroiditis

AbstractBackgroundThe aim of the study was assessing the De Ritis score, an inflammatory marker, in Hashimoto's thyroiditis (HT) patients which is characterized with autoimmunity and chronic inflammation.MethodsBetween October 2021 and October 2022, the subjects in our outpatient clinics diagnosed with thyroiditis and healthy controls enrolled to the study. Age, gender, and laboratory parameters including C‐reactive protein (CRP), alanine (ALT), and aspartate (AST) transaminases, thyroid stimulating hormone (TSH), free T4 (FT4), were obtained and recorded for all participants, retrospectively. Division of AST by ALT was the formula to calculate the De Ritis score. Characteristics and laboratory data of the study and healthy controls were compared.ResultsMedian de Ritis ratio of the HT group (1.11 (0.56)%) was significantly higher than that of the control group (0.91 (0.41)%), (p &lt; .001). A positive and significant correlation between De Ritis score and CRP (r = 0.46, p &lt; .001) values. ROC analysis revealed the sensitivity and the specificity of CRP in predicting HT were higher than those of the De Ritis score. A De Ritis score higher than 0.9% has 67% sensitivity and 50% specificity in selecting patients with thyroiditis (AUC: 0.69, p &lt; .001, 95% CI: 0.63–0.76).ConclusionsWe think that elevated De Ritis score can be used as an adjunctive tool in the diagnosis of HT.

Comparison between presepsin, procalcitonin, and CRP as biomarkers to diagnose sepsis in critically ill patients.

Mortality associated with sepsis continues to remain high. Early diagnosis and aggressive management may improve outcomes. Biomarkers may help in early diagnosis, but the search for an ideal biomarker continues. Presepsin has been introduced as a new biomarker, however, it still needs validation before its use becomes routine. In this study, we aimed to compare the efficacy of various biomarkers in patients with suspected sepsis. A retrospective analysis of 100 patients with suspected infection, admitted in the medical intensive care unit (ICU) was conducted. Diagnosis of sepsis was made on the basis of the current surviving sepsis guidelines criteria. Out of 100 patients, 70 were diagnosed to have sepsis, and overall ICU mortality was 22%. Overall, C-reactive protein (CRP) was positive in 98, procalcitonin in 75, and presepsin in 64 patients. For diagnosis of sepsis the sensitivity, specificity, and AUC, respectively, for CRP was 98.6%, 3.3%, and 0.725. For procalcitonin (>0.5 ng/ml) it was 87.1%, 53.3%, and 0.776, and for procalcitonin (>1 ng/ml) 70%, 70%, and 0.816, respectively. For presepsin sensitivity, specificity, and AUC, respectively, for diagnosis of sepsis was 77.1%, 66.7%, and 0.734. For ICU mortality, sensitivity and specificity for CRP was 95.5% and 1.3%, for procalcitonin (>0.5) 72.7% and 24.4.%, for procalcitonin (>1) 59.1% and 42.3%, and for presepsin 61.5% and 27.3%, respectively. Inflammatory markers may be raised in a large proportion of ICU patients, even in those without sepsis. Procalcitnonin and presepsin had similar efficacy in diagnosing sepsis. However, none of the three biomarkers studied were accurate in predicting ICU mortality.

Pathology stewardship in emergency departments: a single-site, retrospective, cohort study of the value of C-reactive protein in patients with suspected sepsis

Increasing awareness of the importance of pathology stewardship in reducing low value care has led to scrutiny of appropriate laboratory test ordering. The objective of this study is to investigate the value of a commonly ordered laboratory test, the C-reactive protein (CRP), in decisions regarding diagnosis, management and disposition of emergency department (ED) patients with suspected sepsis. Retrospective chart reviews were performed on 1716 adult patients with suspected sepsis presenting to the Townsville University Hospital ED between 1 January 2021 and 30 June 2021. Suspected sepsis was defined as the emergency clinicians' decision to perform a blood culture. A CRP value of 10 mg/L or higher was defined as an elevated CRP. The primary outcome of interest was commencement of antibiotics in ED. Secondary outcomes include hospital admission (ward and ICU), hospital length of stay, mortality, documentation of indication for CRP testing, test parameters of CRP in detecting culture-positive bacteraemia and rates of bacteraemia with presumptive ED diagnosis. This study found no significant association between CRP values and antibiotic commencement (p=0.222), ward admission (p=0.071), ICU admission (p=0.248), hospital length of stay (p=0.164) or mortality (p=1.000). CRP had an area under the curve of 0.58 (95% CI 0.51-0.66) for detecting culture-positive bacteraemia. Sensitivity and specificity of CRP were 62.5% and 47.7%, respectively, at a threshold of 46 mg/dL. CRP testing is of little value in ED patients with suspected sepsis as it does not influence decision making about diagnosis, management, or disposition. Avoiding CRP testing in this patient cohort can contribute to pathology stewardship and optimal use of finite healthcare resources.

Sensitivity and specificity of CRP and symptom screening as tuberculosis screening tools among HIV-positive and negative outpatients at a primary healthcare facility in Lusaka, Zambia: a prospective cross-sectional study

ObjectivesTo evaluate the performance of point-of-care C-reactive protein (CRP) as a screening tool for tuberculosis (TB) using a threshold of 10 mg/L in both people living with HIV (PLHIV) and...

Globulin and Albumin/Globulin Ratios as Potential Biomarkers for the Diagnosis of Acute and Chronic Peri-Prosthetic Joint Infections: A Retrospective Study.

Background: Peri-prosthetic joint infection (PJI) is the most serious complication after prosthetic joint replacement. However, the diagnosis of PJI remains challenging for clinicians because of the lack of a gold standard. The purpose of this study was to investigate the diagnostic significance of serum globulin, albumin/globulin, and other biomarkers in acute and chronic periprosthetic infections. Patients and Methods: A retrospective study of 162 patients with PJI and aseptic loosening between January 2016 and March 2021 at our institution was performed in three groups. There were 20 patients with acute infection in group A, 36 patients with chronic infection in group B, and 106 patients with aseptic loosening in group C. Globulin, albumin/globulin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet count (PLT), mean platelet volume (MPV), d-dimer, and platelet count/mean platelet volume ratio (PMR) levels were recorded. The area under the curve (AUC) was used to measure the diagnostic value of globulin and albumin/globulin with other biomarkers for PJI. Results: Compared with the aseptic loosening group, the acute and chronic PJI group had higher levels of CRP, ESR, d-dimer, globulin, PLT, and PMR (p < 0.01) and lower levels of albumin/globulin and MPV (p < 0.01). The optimal cutoff, AUC, sensitivity, and specificity of CRP, albumin/globulin, ESR, and globulin were: CRP, 8.3 mg/L, 0.903, 78.57%, and 88.68%; albumin/globulin, 1.31, 0.899, 91.07%, and 73.58%; ESR, 32 mm/h, 0.888, 75.%, and 85.85%; globulin, 29.5 g/L, 0.880, 91.07%, and 72.64%. Conclusions: Globulin and albumin/globulin have excellent diagnostic value for acute and chronic PJI and are promising potential biomarkers for the diagnosis of PJI. The diagnostic performance of albumin/globulin is superior to that of ESR and similar to that of CRP.

Sensitivity and Specificity of C-Reactive Protein Against Blood Culture in Patients with Neonatal Sepsis - A Hospital-Based Study

Background: Neonatal septicemia is one of the primary causes of disease and death in low-income countries which makes early diagnosis an important factor to prevent microbial resistance and initiate antibiotic therapy. C-reactive protein is an essential biological indicator that might play an important role in the early detection of neonatal sepsis. Objective: The present study was conducted to determine the sensitivity and specificity of CRP against blood culture in the identification of neonatal sepsis. Methods: This study was carried out on 416 neonates identified with sepsis at the NICU and SICU of the National Institute of Child Health, Karachi, Pakistan for a span of 06 months from April 2022 to September 2022. The first blood sample for the evaluation of CRP and blood culture was drawn at the time of admission. The second sample of CRP and blood culture was drawn 72 hours after the first blood collection. The sensitivity and specificity of CRP were calculated on both occasions. Results: Of the total 416 neonates, 165(39.6 %) patients’ blood culture was positive and in 273 (65.9%) patients CRP was positive. The validation study of CRP in the diagnosis of neonatal septicemia reported sensitivity, specificity, positive predictive value, and negative predictive value to be 87.1%, 45.9%, 52.6%, and 83.7% 72 hours after the admission in comparison to 80.6%, 44.2%, 48.7%, and 77.6% at the time of admission. Conclusion: The high specificity and sensitivity of CRP against blood culture make it an important diagnostic modality that might play a helpful role in the diagnosis of neonatal sepsis.

Values of combined C-reactive protein, procalcitonin and serum amyloid A in differential diagnosis of bacterial and non-bacterial community acquired pneumonia in children

This research aimed to explore the clinical value of C-reactive protein (CRP), procalcitonin (PCT), and serum amyloid A (SAA) in early diagnosis of bacterial pneumonia. CRP, PCT, and SAA levels of children with bacterial pneumonia, children with non-bacterial pneumonia, and healthy children were compared. The sensitivity and specificity of CRP, PCT, and SAA in the diagnosis of bacterial pneumonia in children were compared. CRP, PCT, and SAA levels were significantly lower in healthy children when compared with children with Community acquired pneumonia (CAP). ROC analyses showed that CRP, PCT, and SAA all had good accuracy in distinguishing bacterial pneumonia from non-bacterial pneumonia. The combination of CRP, PCT, and SAA further enhanced the accuracy in distinguishing bacterial pneumonia from non-bacterial pneumonia. In conclusion, the expression levels of CRP, PCT, and SAA could indicate the status of bacterial pneumonia. The combined test of CRP, PCT, and SAA had the highest diagnostic accuracy.

Comparison of the predictive values of CRP, CRP/albumin, RDW, neutrophil/lymphocyte, and platelet/lymphocyte levels in determining the severity of acute pancreatitis in patients with acute pancreatitis according to the BISAP score.

In our study, it was aimed to find out whether it would be possible to determine the disease severity by comparing the values of red cell distribution width (RDW), c-reactive protein (CRP), CRP/albumin, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) in patients with acute pancreatitis according to Bedside Index of Severity in Acute Pancreatitis (BISAP) scores at the time of admission. Five hundred patients diagnosed with acute pancreatitis were included in the study. According to BISAP scores, 388 (77.6 %) patients were evaluated as having mild acute pancreatitis and 112 (22.4 %) patients as having severe acute pancreatitis. In ROC analysis, values of 70.54 % sensitivity and 70.10 % specificity for CRP, 71.43 % sensitivity and 70.88 % specificity for CRP/albumin, 80.36 % sensitivity and 30.30 % specificity for RDW, 75.00 % sensitivity and 43.98 % specificity for NLR, and 55.36 % sensitivity and 38.51 % specificity for PLR were determined. Values of 85.71 % sensitivity and 66.49 % specificity were determined for the NLR-CRP/Albumin-RDW 2** score as a newly created scoring system. CRP/albumin, NLR, PLR, and RDW values ​​were found to be statistically significantly higher in patients with severe acute pancreatitis compared to those with mild acute pancreatitis according to the BISAP score (pthat this scoring system could be a practical and reliable guide in the treatment and follow-up of patients with acute pancreatitis (Tab. 6, Fig. 3, Ref. 22).

C-Reactive Protein and Serum Lactate Dehydrogenase as Diagnostic Parameters in Acute Appendicitis

Background Acute appendicitis is the most common disease requiring urgent surgical attention. Accurate diagnosis of acute appendicitis is based on careful history physical examination laboratory and imaging investigation. Hence this study was done to determine the laboratory values of C-reactive protein CRP and serum lactate dehydrogenase LDH in clinically diagnosed acute appendicitis.Methodology This cross-sectional study was done in the Department of Surgery for a duration of 18 months from December 2019 to June 2021. All the patients with acute appendicitis attending the OPD of Department of Surgery were included. Demographic data such as age gender residence occupation date of admission history of present illness were noted. The diagnosis of acute appendicitis was made based on clinical signs and symptoms. Patients were subjected to routine investigations such as CBC RBS blood grouping CRP levels and serum LDH levels USG of abdomen and pelvis.Results Hundred and ten patients with acute appendicitis were included. Age distribution was from 12 years to 52 years. Majority were noted among 12 ndash 22 years constituting 61.82 of the sample with a mean age years plusmn SD of 23.87plusmn6.79 years. MaleFemale ratio was 1.71. The sensitivity and specificity of C-reactive protein was 99.07 and 50 with negative and positive predictive values of 50 and 99.07 respectively. The sensitivity and specificity of serum LDH was 98.04 and 100 with negative and positive predictive values of 80 and 98.18 respectively.Conclusion CRP can lead to precise prediction of severity of acute appendicitis for the treatment. The inflammatory markers i.e. CRP and LDH can be helpful in the diagnosis when measured together as this increases their specificity and positive predictive value.

Utility of Serum Markers in Obstructive Sleep Apnoea Syndrome: A Case-control Study

Introduction: Obstructive Sleep Apnoea Syndrome (OSAS) consists of cessation of breathing for at least 10 seconds during sleep in spite of inspiratory efforts. The OSAS is an independent risk factor for a number of cardiovascular diseases and cerebrovascular events. The OSAS is diagnosed and assessed by polysomnography which is time consuming and expensive. C-Reactive Protein (CRP) and Creatine Phosphokinase (CPK) are markers of systemic inflammation. Inflammatory component is present in OSA. Biomarkers like CRP and CPK may serve as diagnostic tools which are simpler, cheaper and quicker alternatives. Aim: To study the role of serum markers CRP and CPK in the diagnosis of sleep disordered breathing. Materials and Methods: This was a case-control study, conducted from May 2021 to October 2021, in the Department of Pulmonary Medicine, NRI Medical College, Guntur, Andhra Pradesh, India. Total 50 patients were studied for their various symptoms suggestive of OSAS and confirmed by polysomnography were selected for the study. Total 40 age and weight matched controls were included in the study. The association of serum CRP and CPK with OSA was assessed. The Z-test of difference between two proportions was used to compare gender and smoking status of study participants of the two groups. The p-value &lt;0.05 was reported as statistically significant. Results: The mean CRP in those suffering from obstructive sleep apnoea was 12.075±7 mg/dL with 13.89 in moderate to severe OSAS group and 10.26 in mild cases. The CRP showed statistically significant association (p-value=0.00344) with OSA whereas CPK levels in OSA subjects showed no statistically significant association with OSAS. Sensitivity of CRP and CPK compared to the Apnoea Hypopnea Index (AHI) in the diagnosis of OSAS was 66% and 34%, respectively. Specificity of CRP and CPK was 87.5% for both. Positive predictive value for CRP and CPK was 86.8% and 77.2%, respectively. Conclusion: C-reactive protein, a systemic inflammatory marker has a potential role in the diagnosis of OSAS.

C-reactive protein as a diagnostic marker of neonatal sepsis in association with blood culture a retrospective study at a tertiary care hospital

To evaluate the sensitivity and specificity of C-Reactive protein as a single diagnostic inflammatory biomarker of neonatal sepsis in association with the blood culture.In this study, we retrospectively reviewed the medical records of 330 neonates at a tertiary care hospital at Gurugram from Jan, 2015 to Dec, 2020. The study population included neonates &amp;#60;1month age. Neonates meeting the IPSC criteria (Sepsis 2.0)1 and with a positive culture were considered as neonates with proven sepsis. Neonates with congenital malformations and congenital infections associated with TORCH complex were excluded from the study.Of the 330 neonates screened for sepsis, 32 (10%) had a positive blood culture with raised CRP in 69 (21%) cases. Among the 32 cases with positive blood culture, CRP identified 29 cases. The sensitivity, specificity, positive predictive value, negative predictive values of CRP were 90.6%, 86.5%, 42% and 99% respectively. The area under the curve (AUC) for the CRP ROC analysis was 0.83 with sensitivity of 90.6% and specificity of 91.6% which showed CRP usefulness as the diagnostic inflammatory biomarker of neonatal sepsis.Prematurity (53%) in neonates was the most common risk factor associated with neonatal sepsis. Klebsiella pneumoniae 11 (34%) was the most common pathogen isolated with 73% susceptibility to Ciprofloxacin.C-Reactive protein was found to have a high diagnostic value in terms of sensitivity of 90.6% and specificity of 91.6% when 0.83 is used as a cut off point for diagnosis of neonatal sepsis. Therefore, CRP could be used as diagnostic inflammatory biomarker in resource poor settings.

English

BACKGROUND Acute pancreatitis (AP) is a dormant deadly illness. The range of seriousness of the ailment goes from mellow self-restricting disease to an exceptionally lethal severe necrotizing pancreatitis. The disease has such a variable course that it may manifest as a simple pain in the abdomen to severe haemorrhagic pancreatitis with septicaemic shock, multi-organ dysfunction syndrome and ultimately leading to death. A cost-effective better prognosticative index is needed for the assessment of the severity of AP. Here in this study, we wanted to assess the role of BISAP scoring systems and CRP for analysis and comparing their values to determine the severity of AP and the prognosis of the disease. METHODS A prospective observational study was done on 83 patients diagnosed with AP after fulfilment of inclusion criteria. Patients were subjected to severity index, bedside index for severity in acute pancreatitis (BISAP) score and CRP calculation and statistical analysis was done with SPSS software. RESULTS In our study, AP was more prevalent in males 87.95 % than females 12.05 %. AP was found to be more common in cases ≤ 40 years of age, however, the mean age of presentation was 38.14 ± 12.59 years. We calculated the sensitivity and specificity of the BISAP score and C-reactive protein (CRP) by co-relating it with CT severity index as gold standard according to which the sensitivity was found to be 64 % and specificity was found to be 85 % for BISAP. The sensitivity and specificity of CRP was 64 % and 85 % respectively. CONCLUSIONS BISAP is an easy way to anticipate the severity of AP within 24 hours. It also helps to prognosticate AP. CRP can also be used to aid BISAP in the assessment of severe acute pancreatitis (SAP). KEY WORDS Acute Pancreatitis, BISAP, CRP.

The Role of C-Reactive Protein and White Blood Cell Count as Diagnostic, Prognostic, and Monitoring Markers in Bacterial Orofacial Infections

1) To assess the efficacy of C reactive protein (CRP) and white blood cell count (WBC) levels as diagnostic, prognostic, and monitoring tools for determining the severity of bacterial orofacial infections, length of hospital stay (LOS), and the effectiveness of treatment. 2) To evaluate the sensitivity and specificity of CRP and WBC as inflammatory markers in bacterial orofacial infections. This prospective study included 30 patients. The predictor variables were serial readings of CRP and WBC that were correlated with clinical course of orofacial infection including severity of infection, length of hospital stay, and effectiveness of treatment. P value was set at (<.05). The sample was composed of 30 patients with a mean age of 26.7 years, 47% female. Predrainage CRP and WBC were significantly positive in predicting severity of infection and length of hospital stay. Predrainage CRP readings were elevated in 93% of patients whereas WBC predrainage readings were elevated in only 56% of patients with orofacial infections. Sensitivity and specificity of CRP are 87.5 and 68%, respectively while sensitivity and specificity of WBC are 62.6 and 86.4%, respectively. The results of this study suggest that CRP and WBC are useful diagnostic, prognostic, and monitoring tools in bacterial orofacial infections, with CRP being more sensitive than WBC.

Role of Procalcitonin and C-reactive Protein as Marker of Sepsis in Major Burn Patients: A Systematic Review and Meta-analysis

AIM: Although absolute values for C-reactive protein (CRP) and procalcitonin (PCT) are well known to predict sepsis, it remains unclear how their diagnostic value in major burn patients as metabolic changes in burn patient mimic signs and symptoms for sepsis. This paper attempts to clarify these points for both of the markers. METHODS: A comprehensive literature search of PubMed, Scopus, DOAJ, Web of Science, and the Cochrane Library databases for studies published up to June 1, 2020, that evaluated PCT and/or CRP as a marker for diagnosing sepsis in burn patients was conducted. Review Manager 5.3 was used to analyze the data. RESULTS: A total of 11 literatures were obtained. The combined sensitivity and specificity for PCT as assessed by meta-analysis were 88% and 89%, respectively. The combined sensitivity and specificity of CRP were described as 85.5% and 57.5%, respectively. Meta-analysis cannot be performed for CRP parameters because there are only two literatures that include CRP diagnostic test values. DISCUSSION: PCT and CRP have additional diagnostic value for sepsis in patients with major burns. The pooled sensitivity and specificity of PCT are excellent. Although the difference in sensitivity between PCT and CRP is not very large, there are distinct differences in specificity. A low CRP specificity value will show many “false positives” when CRP is used as a biomarker. CONCLUSION: PCT provides a better diagnostic value than CRP in cases of sepsis in major burn patients. More study on combination of biomarker, clinical presentation, and microbial culture for diagnosing sepsis are needed. Further large-scale research with cohort or case control design should be done.

HNF-1β is a More Sensitive and Specific Marker Than C-Reactive Protein for Identifying Biliary Differentiation in Primary Hepatic Carcinomas

Intrahepatic cholangiocarcinoma (iCCA) needs to be distinguished from hepatocellular carcinoma (HCC) and metastasis, and in the absence of any specific biliary markers, is often a diagnosis of exclusion. Hepatocyte nuclear factor (HNF)-1β is a transcription factor that plays a critical role in bile duct system morphogenesis. To investigate the diagnostic value of HNF-1β to differentiate iCCA from HCC by immunohistochemistry and compare HNF-1β with C-reactive protein (CRP), a previously identified marker for iCCA. Cases of iCCA (n = 75), combined hepatocellular-cholangiocarcinoma (cHCC-CCA) (n = 13) and HCC (n = 65) were included in the study. All cases of iCCA (74 of 74, 100%) expressed HNF-1β compared with CRP expressed in 72.60% (53 of 73). The sensitivity and specificity of HNF-1β to differentiate iCCA from HCC was 100% and 92.31%, whereas the sensitivity and specificity for CRP was 75.58% and 7.79%. The expression of HNF-1β was greater in iCCA and the CCA component of cHCC-CCA compared with CRP (87 of 87, 100% versus 65 of 86, 75.58%; P < .001). On the contrary, CRP was more frequently expressed compared with HNF-1β in HCC and HCC component of cHCC-CCA (71 of 77, 92.21% versus 6 of 78, 7.69%; P < .001). Our data indicate that HNF-1β is a more sensitive and specific marker than CRP for the diagnosis of iCCA and to identify the CCA component in cHCC-CCA. Lack of HNF-1β expression may be used to exclude iCCA from consideration in cases of adenocarcinomas of unknown primary.

Aptamer-based novel Ag-coated magnetic recognition and SERS nanotags with interior nanogap biosensor for ultrasensitive detection of protein biomarker

• An innovative aptamer SERS biosensor for highly sensitive protein biomarker detection was presented. • The biosensor contains SERS tags and novel magnetic capture substrates. • Aptamers against CRP were modified on both SERS tag and magnetic capture substrate for specific recognition. • This method exhibits excellent selectivity and specificity and displays high accuracy in actual human serum samples. • This strategy can be extended to the detection of other biomarkers and hold great promise in the clinical diagnosis. The design of a rapid, simple, and ultrasensitive detection platform of protein biomarkers has become an urgent need in early diagnosis and treatment. Surface-enhanced Raman scattering (SERS) technology, with the unique advantages of ultra-sensitivity and fingerprint recognition, has attracted much attention in biomarker detection. An innovative aptamer SERS biosensor for highly sensitive protein biomarker detection was presented. This biosensor contains a SERS tag (reporter-labeled Au nano-bridged nanogaps particles, Au NNPs) and novel magnetic capture substrate (Ag-coated Fe 3 O 4 -Au NPs, Ag MNPs). C-reactive protein (CRP), a representative biomarker for diagnosing, was used to assess the SERS performance of this biosensor. Aptamers against CRP were modified on both SERS tag and magnetic capture substrate for specific recognition by Au NNPs-CRP-Ag MNPs sandwich assay. This strategy achieved sensitive detection of CRP with a limit of detection (LOD) of 10 fM (1.14 pg/mL), and is much lower than reported analytical methods. Besides, this method exhibits excellent selectivity and specificity for CRP under the interference of other proteins and displays high accuracy in the detection of actual human serum samples. This proposed detection strategy can be extended to the sensitive detection of other biomarker proteins and hold great promise in the clinical diagnosis of diseases.

Maternal inflammatory markers for chorioamnionitis in preterm prelabour rupture of membranes: a systematic review and meta-analysis of diagnostic test accuracy studies

BackgroundThere is no consensus on the role of inflammatory markers in identifying chorioamnionitis in preterm prelabour rupture of membranes (PPROM). We set out to evaluate the accuracy of maternal blood C-reactive protein (CRP), procalcitonin and interleukin 6 (IL6) in diagnosis of histological chorioamnionitis and/or funisitis (HCA/Funisitis) in PPROM.MethodsWe searched MEDLINE, EMBASE and The Cochrane Library from inception to January 2020 for studies where maternal blood CRP, procalcitonin or IL6 was assessed against a reference standard of HCA/Funisitis in PPROM. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess methodological quality. Hierarchical summary receiver operating characteristic (SROC) models were used to construct summary curves. Bivariate models were used to obtain summary estimates for studies with the same cut-off.ResultsWe included 23 studies reporting HCA/Funisitis in 902 of 1717 women, median prevalence 50% (inter-quartile range 38–57). Of these studies, 20 were prospective cohort design and 3 were retrospective cohort. Eleven studies reported the index test against a reference standard of HCA and/or funisitis, 10 reported HCA alone and 2 reported funisitis alone. Many studies had high risk of bias scores on the QUADAS-2 assessment but low concerns for applicability. Sensitivity and specificity for CRP ≥ 20 mg/L (5 studies, 252 participants) was 59% (95% CI 48–69) and 83% (95% CI 74–89) respectively. SROC curves are provided for each index test. At selected specificity of 80%, the sensitivities for CRP (all cut-offs, 17 studies, 1404 participants), PCT ( all cut-offs, 6 studies, 231 participants) and IL6 (all cut-offs, 5 studies, 299 participants) were 59%(95% CI 52–68), 56%(95% CI 50–69) and 52% (95% CI 50–86) respectively.ConclusionsThere is insufficient evidence to support use of CRP, procalcitonin or IL6 in maternal blood for diagnosis of HCA/Funisitis in PPROM. This review followed recommended methodology and data analytic methods that made the most of the data regardless of the different cut-offs used. However, the evidence is based on few studies with generally small sample sizes, poor-quality scores and substantial heterogeneity. There is a need for good-quality diagnostic accuracy studies to better assess the role of these biomarkers in PPROM.Systematic review registrationPROSPERO registration number: CRD42015023899, registered on 8 October 2015.

Previously Derived Host Gene Expression Classifiers Identify Bacterial and Viral Etiologies of Acute Febrile Respiratory Illness in a South Asian Population.

BackgroundPathogen-based diagnostics for acute respiratory infection (ARI) have limited ability to detect etiology of illness. We previously showed that peripheral blood-based host gene expression classifiers accurately identify bacterial and viral ARI in cohorts of European and African descent. We determined classifier performance in a South Asian cohort.MethodsPatients ≥15 years with fever and respiratory symptoms were enrolled in Sri Lanka. Comprehensive pathogen-based testing was performed. Peripheral blood ribonucleic acid was sequenced and previously developed signatures were applied: a pan-viral classifier (viral vs nonviral) and an ARI classifier (bacterial vs viral vs noninfectious).ResultsRibonucleic acid sequencing was performed in 79 subjects: 58 viral infections (36 influenza, 22 dengue) and 21 bacterial infections (10 leptospirosis, 11 scrub typhus). The pan-viral classifier had an overall classification accuracy of 95%. The ARI classifier had an overall classification accuracy of 94%, with sensitivity and specificity of 91% and 95%, respectively, for bacterial infection. The sensitivity and specificity of C-reactive protein (>10 mg/L) and procalcitonin (>0.25 ng/mL) for bacterial infection were 100% and 34%, and 100% and 41%, respectively.ConclusionsPreviously derived gene expression classifiers had high predictive accuracy at distinguishing viral and bacterial infection in South Asian patients with ARI caused by typical and atypical pathogens.