scholarly journals MP48: White blood cells count and C-reactive protein performance to identify severe bacterial infection in the fever without a source workup of infants 22 to 60 days old

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S59-S60
Author(s):  
G. Gravel ◽  
K. Vachon ◽  
M. Giguère ◽  
L. Lajeunesse ◽  
J. Morin ◽  
...  
Keyword(s):  
Blood Cells ◽  
Bacterial Infections ◽  
White Blood Cells ◽  
Added Value ◽  
Quebec City ◽  
C Reactive Protein ◽  
Blood Biomarkers ◽  
Predictive Values ◽  
Reactive Protein ◽  
Sensitivity Specificity

Introduction: Identification of severe bacterial infections (SBI) among infants presenting to the emergency department (ED) for fever without a source (FWS) remains challenging. Controversies persist on the usefulness of blood biomarkers, especially when used for assessing infants 22 to 60 days old. Although C-reactive protein (CRP) and white blood cells count (leucocytes) are commonly prescribed, this practice relies on poor and conflicting evidence. Our objective was to determine the performance of those two markers at identifying SBI. Methods: This is a sub-analysis of an ongoing retrospective cohort study conducted in an academic pediatric ED in Quebec City, that aims to determine whether a lumbar puncture should routinely be performed in the FWS workup of 22 to 60 days old infants. All consecutive charts of eligible febrile infants were reviewed. Premature infants (<37 weeks), as well as infants with chronic diseases, immunodeficiency, previous antimicrobial therapy, in-dwelling catheters, or septic shock were excluded. Among others, data related to final diagnosis and investigations were gathered. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios were estimated for each blood biomarkers. Results: Out of 1261 charts reviewed, 920 patients were included in this analysis. SBI prevalence was 13.0% (95%CI: 10.9-15.2) among infants of our cohort. The sensitivity, specificity, PPV, NPV, LR+ and LR- of the leucocytes <5000 or≥15000/□L were 43% (95%CI: 34-53%), 80% (95%CI: 77-83%), 25% (95%CI: 21-30%), 90% (95%CI: 88-91%), 2.1 (95%CI: 1.7-2.8), and 0.72 (95%CI: 0.61-0.84), respectively. The sensitivity, specificity, PPV and NPV of CRP >= 25 mg/L were 46% (95%CI: 37-56%), 96% (95%CI: 94-97%), 65% (95%CI: 55-73%), and 91% (95%CI: 89-92%), respectively. ROC curves analysis indicates that a CRP≥25 mg/L offers the best LR+ (10.4; 95%CI: 6.9-15.6) with a corresponding LR- of 0.56 (95%CI: 0.47-0.67). Conclusion: When evaluating febrile infants in the ED, leucocytes appear to have limited added value, while CRP≥25 mg/L significantly increases the pre-test probability of SBI. CRP should be considered for inclusion in the workup of FWS for infants of 22 to 60 days of age.

scholarly journals Utility of procalcitonin, C-reactive protein and white blood cells alone and in combination for the prediction of clinical outcomes in community-acquired pneumonia

2015 ◽  
Vol 53 (4) ◽  
Author(s):  
Andriy Zhydkov ◽  
Mirjam Christ-Crain ◽  
Robert Thomann ◽  
Claus Hoess ◽  
Christoph Henzen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Blood Cells ◽  
White Blood Cells ◽  
Community Acquired Pneumonia ◽  
Adverse Clinical Outcome ◽  
C Reactive Protein ◽  
Prognostic Information ◽  
Reactive Protein

AbstractThe added value of biomarkers, such as procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC), as adjuncts to clinical risk scores for predicting the outcome of patients with community-acquired pneumonia (CAP) is in question. We investigated the prognostic accuracy of initial and follow-up levels of inflammatory biomarkers in predicting death and adverse clinical outcomes in a large and well-defined cohort of CAP patients.We measured PCT, CRP and WBC on days 1, 3, 5, and 7 and followed the patients over 30 days. We applied multivariate regression models and area under the curve (AUC) to investigate associations between these biomarkers, the clinical risk score CURB-65, and clinical outcomes [i.e., death and intensive care unit (ICU) admission].Of 925 patients with CAP, 50 patients died and 118 patients had an adverse clinical outcome. None of the initial biomarker levels significantly improved the CURB-65 score for mortality prediction. Follow-up biomarker levels showed significant independent association with mortality at days 3, 5, and 7 and with improvements in AUC. Initial PCT and CRP levels were independent prognostic predictors of adverse clinical outcome, and levels of all biomarkers during the course of disease provided additional prognostic information.This study provides robust insights into the added prognostic value of inflammatory markers in CAP. Procalcitonin, CRP, and to a lesser degree WBC provided some prognostic information on CAP outcomes, particularly when considering their kinetics at days 5 and 7 and when looking at adverse clinical outcomes instead of mortality alone.

scholarly journals The utility of basic blood counts, WBC histogram and C-reactive protein in detecting malaria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Nishimura ◽  
Parag Dharap ◽  
Sebastien Raimbault
Keyword(s):  
Blood Cells ◽  
Malaria Infection ◽  
Monsoon Season ◽  
Characteristic Curve ◽  
White Blood Cells ◽  
C Reactive Protein ◽  
Control Groups ◽  
Reactive Protein ◽  
Hematology Analyzer ◽  
And Control

Abstract Background Hematology analyzers display abnormal parameters during malaria infection providing insightful information for suspecting and assessing malaria infection. The goal of this study is to demonstrate the potential of a three-part differential hematology analyzer to assess malaria, provide information about the parasitemia, and discuss the importance of combining C-reactive protein (CRP) with hematology parameters to obtain further information about the malaria infection. Methods The present study shows the results of a case–control study during the monsoon season of years 2018 and 2019 in Mumbai, India. The study considers 1008 non-malaria febrile cases, 209 P. vivax and 31 P. falciparum positive malaria samples, five cases of mixed P. vivax and P. falciparum infection, and three co-infection cases of P. vivax and dengue. Raw data from the three-part analyzer LC-667G CRP (HORIBA) and the corresponding microscopic findings (golden standard for diagnosis of malaria) were obtained for each sample. Results The medians of platelet counts (PLT) were 102.5, 109.0, and 223.0 × 103/µL, while CRP medians were 67.4, 81.4 and 10.4 mg/L in P. vivax, P. falciparum and control groups respectively (p < 0.001 in Mann–Whitney U tests between malaria and control groups). Compared with negative samples, platelets counting less than 161.5 × 103/µL were observed on malaria patients (OR 19.12, 95% CI 11.89–30.75). Especially in P. vivax cases, an abnormal peak was frequently observed in the white blood cells (WBC) histogram around the 37fL channel. The events counted around that channel showed a linear correlation with the counting of red blood cells infected predominantly with larger parasitic forms. Parameters like CRP (rs = 0.325, p < 0.001), WBC (rs = 0.285, p < 0.001) and PLT (rs = − 0.303, p < 0.001) were correlated with the parasitemia of P. vivax samples. Between the malaria and dengue groups, the highest area under the receiver operating characteristic curve was observed on CRP (0.867, CRP ≥ 26.85 mg/L). Conclusions A three-part differential hematology analyzer has the potential to not only trigger malaria diagnosis confirmation but also assess the severity of the infection when CRP is considered.

scholarly journals Role Of C-Reactive Protein in Diagnosis of Acute Appendicitis

2021 ◽  
Vol 10 (4) ◽  
pp. 210-214
Author(s):  
Mirza Tassawar Hussain ◽  
Muhammad Kashif Khan ◽  
Syed Shamsuddin ◽  
Aabid Ali ◽  
Erum Khan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
C Reactive Protein ◽  
Diagnostic Dilemma ◽  
Senior Registrar ◽  
Predictive Values ◽  
Reactive Protein ◽  
Highly Sensitive ◽  
Sensitivity Specificity

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis. Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23. Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively. Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.  

Acute Hemodynamic Responses to Combined Exercise and Sauna

2020 ◽  
Vol 41 (12) ◽  
pp. 824-831 ◽  
Author(s):  
Joonas Antero Rissanen ◽  
Keijo Häkkinen ◽  
Jari Antero Laukkanen ◽  
Arja Häkkinen
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Endurance Exercise ◽  
Plasma Volume ◽  
Blood Cells ◽  
White Blood Cells ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Positive Effects ◽  
Volume Measurements

AbstractThis study investigated acute hemodynamic, plasma volume and immunological responses to four loading protocols: sauna only, and sauna after endurance, strength or combined endurance and strength exercise. Twenty-seven healthy, slightly prehypertensive men (age 32.7±6.9 years) were measured at PRE, MID (after exercise), POST, POST30min and POST24h. The measurements consisted systolic and diastolic blood pressure, heart rate, body temperature and concentrations of high-sensitive C-reactive protein, white blood cells and plasma volume measurements. Endurance+sauna showed significant decreases in systolic blood pressure at POST (–8.9 mmHg), POST30min (–11.0 mmHg) and POST24h (–4.6 mmHg). At POST30min, significant decreases were also observed in sauna (–4.3 mmHg) and combined+sauna (–7.5 mmHg). Diastolic blood pressure decreased significantly from -5.4 to –3.9 mmHg at POST in all loadings. Plasma volume decreased significantly at MID in all exercise loadings and at POST in endurance+sauna and strength+sauna. Plasma volume increased significantly (p < 0.01) in endurance+sauna and combined+sauna at POST24h. White blood cells increased following all exercise+sauna loadings at MID, POST and POST30min, whereas high sensitive C-reactive protein showed no changes at any measurement point. The combination of endurance exercise and sauna showed the greatest positive effects on blood pressure. Both loadings including endurance exercise increased plasma volume on the next day.

scholarly journals Su1095 – Serum C Reactive Protein and White Blood Cells Count As Early Predictor of Complication in Mayor Abdominal Surgery

2019 ◽  
Vol 156 (6) ◽  
pp. S-1438
Author(s):  
Bernardo Borraez-Segura ◽  
Manuel Mena ◽  
Felipe Anduquia ◽  
Natalia Hurtado ◽  
Santiago Bedoya ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Blood Cells ◽  
White Blood Cells ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Early Predictor

scholarly journals Diagnostic Accuracy of Procalcitonin, Neutrophil-to-Lymphocyte Ratio, and C-Reactive Protein in Detection of Bacterial Infections and Prediction of Outcome in Nonneutropenic Febrile Patients with Lung Malignancy

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Shanshan Ding ◽  
Jun Ma ◽  
Xingguo Song ◽  
Xiaohan Dong ◽  
Li Xie ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Bacterial Infections ◽  
White Blood Cells ◽  
Neutrophil To Lymphocyte Ratio ◽  
C Reactive Protein ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Retrospective Clinical Study ◽  
The Absolute

Background. Procalcitonin (PCT), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) have emerged as important markers of inflammation, and these markers, especially PCT and CRP, have been studied in patients with neutropenia. This study was designed to evaluate their value in differentiating infectious fever from tumor fever (TF) and to investigate their role in assessing outcomes in nonneutropenic lung cancer patients (NNLCPs). Methods. This retrospective clinical study included 588 febrile NNLCPs between January 2019 and December 2019. The levels of PCT, CRP, and conventional inflammatory markers, including white blood cells (WBC) and neutrophils (NEU), were measured. NLR was defined as the ratio of the absolute neutrophil count to the absolute lymphocyte count. Patients’ clinical and bacteriological data were recorded. Results. This study included 311 NNLCPs with bacterial infections and 277 with TF. Inflammatory markers such as PCT, CRP, WBC, and NEU levels and NLR were significantly higher in patients with bacterial infections than in those with TF (p < 0.0001). However, PCT level was the best predictor of bacterial infections, with an area under the curve (AUC) of 0.874, followed by CRP level (AUC = 0.855) and NLR (AUC = 0.792) (p < 0.0001). Additionally, PCT level was significantly elevated in patients with bacterial infections with progressive disease after radiotherapy and chemotherapy (p < 0.01). Conclusions. The present study demonstrated the superiority of PCT over CRP and NLR in the diagnosis of febrile patients with bacterial infections. Additionally, PCT can be used to assess the clinical outcomes and cancer progression in NNLCPs.

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