scholarly journals The role of serum C-reactive protein in the diagnosis of periprosthetic shoulder infection

2021 ◽  
Author(s):  
Doruk Akgün ◽  
Mats Wiethölter ◽  
Paul Siegert ◽  
Victor Danzinger ◽  
Marvin Minkus ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Joint Infection ◽  
Receiver Operating Curve ◽  
C Reactive Protein ◽  
Level Of Evidence ◽  
Reactive Protein ◽  
Median Serum ◽  
Cutibacterium Acnes ◽  
Serum Crp ◽  
Receiver Operating

Abstract Introduction There is a paucity of literature regarding serum C-reactive protein (CRP) in the evaluation of a shoulder periprosthetic joint infection (PJI). The purpose of the current study was to establish cutoff values for diagnosing shoulder PJI and evaluate the influence of the type of infecting microorganism and the classification subgroups according to last proposed International Consensus Meeting (ICM) criteria on the CRP level. Materials and methods A retrospective analysis of all 136 patients, who underwent septic or aseptic revision shoulder arthroplasty in our institution between January 2010 and December 2019, was performed. Shoulder PJI was defined according to the last proposed definition criteria of the ICM. Serum CRP levels were compared between infected and non-infected cases, between infection subgroups, as well as between different species of infecting microorganisms. A receiver-operating characteristic (ROC) analysis was performed to display sensitivity and specificity of serum CRP level for shoulder PJI. Results A total of 52 patients (38%) were classified as infected, 18 meeting the criteria for definitive infection, 26 for probable infection and 8 for possible infection. According to the ROC curve, an optimized serum CRP threshold of 7.2 mg/l had a sensitivity of 69% and specificity of 74% (area under curve = 0.72). Patients with definitive infection group demonstrated significantly higher median serum CRP levels (24.3 mg/l), when compared to probable, possible infection groups and PJI unlikely group (8 mg/l, 8.3 mg/l, 3.6 mg/l, respectively, p < 0.05). The most common isolated microorganism was Cutibacterium acnes in 25 patients (48%) followed by coagulase-negative staphylococci (CNS) in 20 patients (39%). Patients with a PJI caused by high-virulent microorganisms had a significantly higher median serum CRP level compared to patients with PJI caused by low-virulent microorganisms (48 mg/l vs. 11.3 mg/l, p = 0.04). Conclusions Serum CRP showed a low sensitivity and specificity for the diagnosis of shoulder PJI, even applying cutoffs optimized by receiver-operating curve analysis. Low-virulent microorganisms and patients with probable and possible infections are associated with lower CRP levels compared to patients with definitive infection and infections caused by high-virulent microorganisms. Level of evidence Diagnostic Level III.

The serum level of C-reactive protein alone cannot be used for the diagnosis of prosthetic joint infections, especially in those caused by organisms of low virulence

2018 ◽  
Vol 100-B (11) ◽  
pp. 1482-1486 ◽  
Author(s):  
D. Akgün ◽  
M. Müller ◽  
C. Perka ◽  
T. Winkler
Keyword(s):  
Correlation Coefficient ◽  
False Negative ◽  
Causative Organism ◽  
Spearman Correlation ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Prosthetic Joint ◽  
Median Serum ◽  
Prosthetic Joint Infections ◽  
Serum Crp

Aims The aim of this study was to determine the prevalence and characteristics of C-reactive protein (CRP)-negative prosthetic joint infection (PJI) and evaluate the influence of the type of infecting organism on the CRP level. Patients and Methods A retrospective analysis of all PJIs affecting the hip or knee that were diagnosed in our institution between March 2013 and December 2016 was performed. A total of 215 patients were included. Their mean age was 71 years (sd 11) and there were 118 women (55%). The median serum CRP levels were calculated for various species of organism and for patients with acute postoperative, acute haematogenous, and chronic infections. These were compared using the Kruskal–Wallis test, adjusting for multiple comparisons with Dunn’s test. The correlation between the number of positive cultures and serum CRP levels was estimated using Spearman correlation coefficient. Results Preoperative CRP levels were normal (< 10 mg/l) in 77 patients (35.8%) with positive cultures. Low-virulent organisms were isolated in 66 PJIs (85.7%) with normal CRP levels. When grouping organisms by species, patients with an infection caused by Propionibacterium spp., coagulase-negative staphylococci (CNS), and Enterococcus faecalis had significantly lower median serum CRP levels (5.4 mg/l, 12.2 mg/l, and 23.7 mg/l, respectively), compared with those with infections caused by Staphylococcus aureus and Streptococcus spp. (194 mg/l and 89.3 mg/l, respectively; p < 0.001). Those with a chronic PJI had statistically lower median serum CRP levels (10.6 mg/l) than those with acute postoperative and acute haematogenous infections (83.7 mg/l and 149.4 mg/l, respectively; p < 0.001). There was a significant correlation between the number of positive cultures and serum CRP levels (Spearman correlation coefficient, 0.456; p < 0.001). Conclusion The CRP level alone is not accurate as a screening tool for PJI and may yield high false-negative rates, especially if the causative organism has low virulence. Aspiration of the joint should be used for the diagnosis of PJI in patients with a chronic painful arthroplasty, irrespective of CRP level. Cite this article: Bone Joint J 2018;100-B:1482–86.

scholarly journals Assessment of a Multiplex Serological Test for the Diagnosis of Prosthetic Joint Infection: a Prospective Multicentre Study

2020 ◽  
Vol 5 (2) ◽  
pp. 89-95 ◽  
Author(s):  
Pascale Bémer ◽  
Céline Bourigault ◽  
Anne Jolivet-Gougeon ◽  
Chloé Plouzeau-Jayle ◽  
Carole Lemarie ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Serological Test ◽  
Bacterial Species ◽  
Joint Infection ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Cutibacterium Acnes

Abstract. Introduction: The diagnosis of prosthetic joint infections (PJIs) can be difficult in the chronic stage and is based on clinical and paraclinical evidence. A minimally invasive serological test against the main pathogens encountered during PJI would distinguish PJI from mechanical loosening.Methods: We performed a prospective, multicentre, cross-sectional study to assess the contribution of serology in the diagnosis of PJI. Over a 2-year period, all patients undergoing prosthesis revision were included in the study. A C-reactive protein assay and a serological test specifically designed against 5 bacterial species (Staphylococcus aureus, S. epidermidis, S. lugdunensis, Streptococcus agalactiae, Cutibacterium acnes) were performed preoperatively. Five samples per patient were taken intraoperatively during surgery. The diagnosis of PJI was based on clinical and bacteriological criteria according to guidelines.Results: Between November 2015 and November 2017, 115 patients were included, 49 for a chronic PJI and 66 for a mechanical problem. Among patients with PJI, a sinus tract was observed in 32.6% and a C-reactive protein level ≥10 mg/L in 74.5%. The PJI was monomicrobial in 43 cases (targeted staphylococci, 24; S. agalactiae, 1; C. acnes, 2; others, 16), and polymicrobial in 6 cases (12.2%). Sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 82.1%, 58.3% and 90.8%, respectively, for targeted staphylococci. Specificity/negative predictive value was 97.3%/100% for S. agalactiae and 83.8% /96.9% for C. acnes.Conclusions: The serological tests are insufficient to affirm the diagnosis of PJI for the targeted bacteria. Nevertheless, the excellent NPV may help clinicians to exclude PJI.

scholarly journals The Role of Serum Fibrinogen in Predicting Reinfection after DAIR (debridement, antibiotics, and implant retention) Treatment of Periprosthetic Joint Infections

2021 ◽  
Author(s):  
Dacheng Zhao ◽  
He Jinwen ◽  
Wang Xingwen ◽  
Zhao Xiaobing ◽  
Bin Geng ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Joint Infection ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Joint Infections ◽  
Implant Retention

Abstract Background Fibrinogen (FIB) has been used to differentiate periprosthetic joint infection (PJI) from aseptic loosening. The purpose of this study was to evaluate the diagnostic value of FIB in predicting postoperative reinfection in patients with debridement, antibiotics and implant retention (DAIR). Methods We retrospectively analyzed the patients who were admitted to DAIR from January 2013 to August 2019 for consideration of PJI readmission. Subgroups were divided into subgroups based on whether there was reinfection after DAIR treatment, and the diagnostic value of serum fibrinogen, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before DAIR treatment was analyzed by receiver operating Characteristic curve (ROC). To evaluate the diagnostic value of FIB in predicting postoperative reinfection in DAIR patients. Results FIB expression was different in acute PJI patients and chronic PJI patients treated with DAIR (4.03 VS 3.08; P < .05, 4.28 VS 3.68; P < .05). In patients with acute PJI treated with DAIR, the sensitivity and specificity of FIB were 81.82% and 83.33%, respectively, significantly higher than CRP (sensitivity, 72.73%; Specificity, 50%; P < .05), while the specificity was higher than ESR (specificity,41.67%; P < .05). In patients with chronic PJI treated with DAIR, the sensitivity and specificity of FIB were 80.00% and 66.66%, respectively, significantly higher than CRP (sensitivity, 53.33%; Specificity, 66.66%; P < .05), ESR (sensitivity was 66.00%; Specificity, 16.66 %; P < .05). Conclusion FIB can predict reinfection after DAIR treatment for acute or chronic PJI. Considering the low success rate of DAIR treatment for chronic PJI, it should be chosen carefully.

scholarly journals The Relationship of C-reactive Protein/interleukin-6 Concentrations Between Serum and Synovial Fluid in the Diagnosis of Periprosthetic Joint Infection

2021 ◽  
Author(s):  
Bao-Zhan Yu ◽  
Rui Li ◽  
Xiang Li ◽  
Wei Chai ◽  
Yong-Gang Zhou ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Interleukin 6 ◽  
Joint Infection ◽  
C Reactive Protein ◽  
Musculoskeletal Infection ◽  
Reactive Protein ◽  
Serum Crp ◽  
Relationship Of ◽  
The Relationship

Abstract Background: The relationship of C-reactive protein (CRP)/interleukin-6 (IL-6) concentrations between serum and synovial fluid and whether synovial CRP/IL-6 testing in addition to serum CRP/IL-6 testing would result in a benefit in the diagnosis of periprosthetic joint infection (PJI) deserves to be investigated.Methods: From June 2016 to July 2019, 139 patients were included in the study. Synovial CRP and IL-6 were tested by ELISA. The serum CRP and IL-6 were obtained from medical records. The definition of PJI was based on the modified Musculoskeletal Infection Society (MSIS) criteria. The relationship of serum and synovial CRP and IL-6 and the value of each index in the diagnosis of PJI were evaluated.Results: The Receiver operating characteristic（ROC）curves showed that synovial IL-6 had the highest area under the curve（AUC） at 0.935, which was followed by synovial CRP, serum IL-6 and serum CRP 0.861, 0.847 and 0.821, respectively. When combining serum CRP and synovial CRP to diagnose PJI, the AUC was 0.849, which was slightly higher than the result obtained when using serum CRP alone. In contrast, when combining serum IL-6 and synovial IL-6 to diagnose PJI, the AUC increased to 0.940, which was significantly higher than that obtained using serum IL-6 alone.Conclusion: The synovial IL-6 has the highest diagnostic accuracy for PJI. However，inferring the level of CRP/IL-6 in the synovial fluid from the serum level of CRP/IL-6 was not feasible. Synovial CRP testing did not offer an advantage when combined with an existing serum CRP result to diagnose PJI, while additional synovial IL-6 was worthy of testing even if there was an existing serum IL-6 result.

scholarly journals Combined serum and synovial C-reactive protein tests: a valuable adjunct to the diagnosis of chronic prosthetic joint infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hai Wang ◽  
Leilei Qin ◽  
Jiawei Wang ◽  
Ning Hu ◽  
Wei Huang
Keyword(s):  
Predictive Value ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Combined Model ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Valuable Adjunct ◽  
Serum Crp

Abstract Background Diagnosis of periprosthetic joint infection (PJI), especially chronic PJI, is very confusing and challenging. The value of C-reactive protein (CRP) in infectious diseases has been recognized, but the diagnostic value of CRP in chronic PJI is unknown. Our aim was to investigate the diagnostic value of synovial CRP in chronic PJI and to explore the role of combined serum and synovial CRP in distinguishing chronic PJI from aseptic failure after knee and hip arthroplasties. Methods We prospectively enrolled patients scheduled to have a revision surgery for chronic PJI or aseptic loosening from January 2019 to December 2020, in which synovial CRP was additionally measured along with routine preoperative diagnostic serum ((ESR, CRP) and synovial (PMN%) biomarkers. The receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker to determine diagnostic efficacy. Results There were no statistically significant differences between the infection (n = 39) and aseptic (n = 58) groups, including 61 hips and 36 knees. The synovial CRP levels were significantly higher in the infection group than in the aseptic group (median: 9.93 mg/l vs 3.58 mg/l; p < .001). The optimal cut-off value for detecting chronic PJI of Synovial fluid (SF) CRP was of 7.26 mg/l with a sensitivity of 84.62%, a specificity of 93.10%. The combined model I (Serum CRP > 10.2 mg/l OR SF CRP > 7.26 mg/l) had a negative predictive value (NPV) of 96.67%, and a sensitivity of 97.44%. The combined model II (Serum CRP > 10.2 mg/l AND Synovial CRP > 7.26 mg/l) led to a specificity of 1, and a positive predictive value (PPV) of 1. Conclusions The present study demonstrated that the combination of serum and synovial CRP can be used as an adjunct to the diagnosis of chronic PJI.

scholarly journals Combined Serum and Synovial C-Reactive Protein Tests: An Economical and Efficient Adjunct to the Diagnosis of Chronic Prosthetic Joint Infection

2021 ◽  
Author(s):  
Hai Wang ◽  
Leilei Qin ◽  
Jiawei Wang ◽  
Ning Hu ◽  
Wei Huang
Keyword(s):  
Predictive Value ◽  
Demographic Data ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Combined Model ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Serum Crp

Abstract Background Diagnosis of Periprosthetic joint infection (PJI) is very complex and challenging, especially for chronic PJI. The value of C-reactive protein (CRP) in infectious diseases has been recognized, but the diagnostic value of CRP in chronic PJI is unknown. Our objective was to investigate the effectiveness of synovial CRP in chronic PJI and to determine the optimal combination of serum and synovial CRP in distinguishing chronic PJI from aseptic failure after knee and hip arthroplasties. Methods From January 2018 to December 2019, we prospectively included patients scheduled to have a revision surgery for chronic PJI or aseptic loosening of an implant, in which synovial CRP was additionally measured along with routine preoperative diagnostic serum and synovial biomarkers. The receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker to determine diagnostic efficacy. Results There were no statistically significant differences in demographic data among the 97 cases we eventually included. the synovial CRP levels were significantly higher in the infection group than in the aseptic group (median: 19 mg/l vs. 9.25 mg/l; p = .001). The optimal cut-off value for detecting chronic PJI of synovial CRP was of 7.26 mg/l with a sensitivity of 84.62%, a specificity of 93.10%. The combined model I (Serum CRP > 10.2 mg/l OR SF CRP > 7.2 6 mg/l) had a negative predictive value (NPV) of 96.67%, and a sensitivity of 97.44%. The combined model II (Serum CRP > 10.2 mg/l AND Synovial CRP > 7.26 mg/l) led to a specificity of 1, and a positive predictive value (PPV) of 1. Conclusion The present study demonstrated that the combination of serum and synovial CRP can be used as an adjunct to the diagnosis of chronic PJI.

scholarly journals Serum C-reactive protein levels in severe and very severe pneumonia in children

2012 ◽  
Vol 52 (3) ◽  
pp. 161
Author(s):  
Ni Putu Sucita Wahyu Dewi ◽  
Putu Siadi Purniti ◽  
Roni Naning
Keyword(s):  
Severe Pneumonia ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Pneumonia Severity ◽  
Protein Levels ◽  
Reactive Protein ◽  
Median Serum ◽  
Serum Crp

Background Pneumonia is a major cause of death in children fromdeveloping countries. It is difficult to assess pneumonia severity ifclinical symptoms of pneumonia are unclear, co-morbidities occursimultaneously, or there is an absence of consolidation or infiltrateson chest radiograph. Examination of C-reactive protein (CRP)levels can help to determine the severity of pneumonia.Objective To compare serum CRP levels in severe and very severepneumonia cases.Methods This was a cross-sectional study on pediatric patientsaged> 28 days up to 60 months v.ith a diagnosis of severe or verysevere pneumonia. Subjects were hospitalized at the Departmentof Child Health, Udayana University Medical SchooliSanglahHospital, Denpasar from May 2010 to January 2011. There were30 subjects in each group, severe or very severe pneumonia. Datawere analyzed using Mann-Whitney and ANCOVA tests withstatistical significance set at P < 0.05.Results There were significant differences in median serum CRPlevels in the severe and very severe pneumonia groups. The verysevere pneumonia group had a median CRP level of 54.75 mgiL(lQrange 0.22 to 216.00) and the severe pneumonia group had amedian CRP level ofl6.06 mgiL (IQ range 0.97 to 89.35). SerumCRP levels were influenced by the severity of pneumonia (P =0.002) and the timing of the CRP examination (P = 0.001).Conclusion Subjects with very severe pneumonia hadsignificantly higher median CRP level compared to that of subjectswith severe pneumonia. [Paediatr Indones. 2012;52:161A].

What Are the Indications for Aspiration of a Possibly Infected Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 24S-25S
Author(s):  
Milena M. Plöeger ◽  
Amiethab Aiyer
Keyword(s):  
Sedimentation Rate ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
C Reactive Protein ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Reactive Protein ◽  
Joint Aspiration ◽  
Erythrocyte Sedimentation

Recommendation: Whenever a periprosthetic joint infection (PJI) of a total ankle arthroplasty (TAA) is clinically possible or suspected, especially when elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels exist, and in correspondence to the literature on PJI in total hip and knee arthroplasties, joint aspiration is indicated. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

scholarly journals The relationship of C-reactive protein/interleukin-6 concentrations between serum and synovial fluid in the diagnosis of periprosthetic joint infection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bao-Zhan Yu ◽  
Rui Li ◽  
Xiang Li ◽  
Wei Chai ◽  
Yong-Gang Zhou ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Interleukin 6 ◽  
Joint Infection ◽  
C Reactive Protein ◽  
Musculoskeletal Infection ◽  
Reactive Protein ◽  
Serum Crp ◽  
Relationship Of ◽  
The Relationship

Abstract Background The relationship of C-reactive protein (CRP)/interleukin-6 (IL-6) concentrations between serum and synovial fluid and whether synovial CRP/IL-6 testing in addition to serum CRP/IL-6 testing would result in a benefit in the diagnosis of periprosthetic joint infection (PJI) deserves to be investigated. Methods From June 2016 to July 2019, 139 patients were included in the study. Synovial CRP and IL-6 were tested by ELISA. The serum CRP and IL-6 were obtained from medical records. The definition of PJI was based on the modified Musculoskeletal Infection Society (MSIS) criteria. The relationship of serum and synovial CRP and IL-6 and the value of each index in the diagnosis of PJI were evaluated. Results The receiver operating characteristic (ROC) curves showed that synovial IL-6 had the highest area under the curve (AUC) at 0.935, which was followed by synovial CRP, serum IL-6 and serum CRP 0.861, 0.847 and 0.821, respectively. When combining serum CRP and synovial CRP to diagnose PJI, the AUC was 0.849, which was slightly higher than the result obtained when using serum CRP alone. In contrast, when combining serum IL-6 and synovial IL-6 to diagnose PJI, the AUC increased to 0.940, which was significantly higher than that obtained using serum IL-6 alone. Conclusion The synovial IL-6 has the highest diagnostic accuracy for PJI. However, inferring the level of CRP/IL-6 in the synovial fluid from the serum level of CRP/IL-6 was not feasible. Synovial CRP testing did not offer an advantage when combined with an existing serum CRP result to diagnose PJI, while additional synovial IL-6 was worthy of testing even if there was an existing serum IL-6 result.

scholarly journals Combined Analysis of C-reactive Protein in Pleural Fluid and Serum is Effective in the Differential Diagnosis of Exudative Pleural Effusions

2021 ◽  
Author(s):  
Shuo-yao Qu ◽  
Yong Zhang ◽  
Shuo Wu ◽  
Ming-ming Wang ◽  
Ling-li Liu ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Receiver Operating Characteristic ◽  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Operating Characteristic ◽  
C Reactive Protein ◽  
Characteristic Analysis ◽  
Combined Analysis ◽  
Reactive Protein ◽  
Receiver Operating

Abstract Background: Exudative pleural effusion (EPE) is one of the common pleural manifestations of various diseases. Differential diagnosis of EPE is imperative clinically as it identifies different causes of EPE, thereby, providing effective treatments. Thoracoscopy is a useful tool for differential diagnosis of EPE. However, some patients would refuse thoracoscopic examination due to its invasive nature. In addition, the specificity and sensitivity of existing routine tests of EPE are less satisfying. Therefore, there is a great need to establish an effective method for differential diagnosis of EPE.Methods: This study was a single-institution retrospective analysis of diagnostic efficiency of C-reactive protein (CRP) and procalcitonin (PCT) between March 2018 and September 2018. Eighty-seven patients diagnosed with EPE were enrolled. All patients underwent diagnostic thoracentesis. And the EPE was examined using biochemical, routine, microbiological, and cytological methods. Pathological cytology detection was of necessity for those with the suspicion of malignant PE. Benign PE comes from patients with pneumonia, empyema and tuberculosis. The levels of CRP and PCT of EPE and serum were measured before the treatment. Correlation analysis and receiver-operating characteristic (ROC) curve analysis were conducted to determine the underlying relationship between levels of CRP and PCT, and differential diagnosis.Results: Receiver operating characteristic analysis showed that the sensitivity and specificity for the analysis of pleural fluid CRP (p-CRP) are higher (cut-off: 17.55 pg/mL; sensitivity: 75.00 %, specificity: 83.90%) than that of serum CRP (s-CRP, cut-off: 23.90 pg/mL; sensitivity: 71.00 %, specificity: 80.4%) in the differential diagnosis for EPE. However, the analysis of pleural fluid PCT (p-PCT) and serum PCT (s-PCT) didn’t demonstrate correlations with EPE. Combined analysis of p-CRP (cut-off: 17.55 mg/dL) with s-CRP (cut-off: 23.9 pg/mL) showed the highest diagnostic accuracy (88.4%) in diagnosing infectious EPE.Conclusions: The data support the close relationship between combined analysis of p-CRP with s-CRP and effective and accurate differential diagnosis of EPE, due to its higher sensitivity and specificity. However, as a highly sensitive marker to diagnose bacterial infections, neither s-PCT nor p-PCT, showed correlations with the differential diagnosis of EPE.

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