Sensitivity of C-reactive protein cut-off values for pyogenic spinal infection in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 836-843
Author(s):  
William T. Davis ◽  
Michael D. April ◽  
Sumeru Mehta ◽  
Brit Long ◽  
Gregory Boys ◽  
...  
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Validation Cohort ◽  
High Sensitivity ◽  
Spinal Infection ◽  
C Reactive Protein ◽  
Imaging Evaluation ◽  
Derivation Cohort ◽  
Reactive Protein ◽  
Test Characteristics

ABSTRACTObjectivesThe aim of this study was to describe the sensitivity of various C-reactive protein (CRP) cut-off values to identify patients requiring magnetic resonance imaging evaluation for pyogenic spinal infection among emergency department (ED) adults presenting with neck or back pain.MethodsWe prospectively enrolled a convenience series of adults presenting to a community ED with neck or back pain in whom ED providers had concern for pyogenic spinal infection in a derivation cohort from 2004 to 2010 and a validation cohort from 2010 to 2018. The validation cohort included only patients with pyogenic spinal infection. We analysed diagnostic test characteristics of various CRP cut-off values.ResultsWe enrolled 232 patients and analysed 201 patients. The median age was 55 years, 43.8% were male, 4.0% had history of intravenous drug use, and 20.9% had recent spinal surgery. In the derivation cohort, 38 (23.9%) of 159 patients had pyogenic spinal infection. Derivation sensitivity and specificity of CRP cut-off values were > 3.5 mg/L (100%, 24.8%), > 10 mg/L (100%, 41.3%), > 30 mg/L (100%, 61.2%), and > 50 mg/L (89.5%, 69.4%). Validation sensitivities of CRP cut-off values were > 3.5 mg/L (97.6%), > 10 mg/L (97.6%), > 30 mg/L (90.4%), and > 50 mg/L (85.7%).ConclusionsCRP cut-offs beyond the upper limit of normal had high sensitivity for pyogenic spinal infection in this adult ED population. Elevated CRP cut-off values of 10 mg/L and 30 mg/L require validation in other settings.

P2.16: Pain and high-sensitivity C-reactive protein in patients with chronic or acute back pain

2004 ◽  
Vol 46 (S1) ◽  
pp. 129-129
Author(s):  
Til Stürmer ◽  
Elke Raum ◽  
Matthias Buchner ◽  
Katja Gebhardt ◽  
Marcus Schiltenwolf ◽  
...  
Keyword(s):  
Back Pain ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Acute Back Pain

scholarly journals High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e015112 ◽  
Author(s):  
Ryo Yoshinaga ◽  
Yasufumi Doi ◽  
Katsuhiko Ayukawa ◽  
Shizukiyo Ishikawa
Keyword(s):  
Cardiovascular Disease ◽  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
High Sensitivity ◽  
Inhospital Mortality ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp

ObjectiveWe investigated whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are associated with inhospital mortality in patients with cardiovascular disease (CVD).DesignA retrospective cohort study.SettingED of a teaching hospital in Japan.Participants12 211 patients with CVD aged ≥18 years who presented to the ED by an ambulance between 1 February 2006 and 30 September 2014 were evaluated.Main outcome measuresInhospital mortality.Results1156 patients had died. The inhospital mortality increased significantly with the hs-CRP levels (<3.0 mg/L: 7.0%, 95% CI 6.4 to 7.6; 3.1–5.4 mg/L: 9.6%, 95% CI 7.9 to 11.3: 5.5–11.5 mg/L: 11.2%, 95% CI 9.4 to 13.0; 11.6–33.2 mg/L: 12.3%, 95% CI 10.5 to 14.1 and ≥33.3 mg/L: 19.9%, 95% CI 17.6 to 22.2). The age-adjusted and sex-adjusted HR for total mortality was increased significantly in the three ≥5.5 mg/L groups compared with the <3.0 mg/L group (5.5–11.5 mg/L: HR=1.32, 95% CI 1.09 to 1.60, p=0.005; 11.6–33.2 mg/L: HR=1.38, 95% CI 1.14 to 1.65, p=0.001 and ≥33.3 mg/L: HR=2.15, 95% CI 1.84 to 2.51, p<0.001). Similar findings were observed for the CVD subtypes of acute myocardial infarction, heart failure, cerebral infarction and intracerebral haemorrhage. This association remained unchanged even after adjustment for age, sex and white cell count and withstood Bonferroni adjustment for multiple testing. When the causes of death were divided into primary CVD and non-CVD deaths, the association between initial hs-CRP levels and mortality remained significant, but the influence of hs-CRP levels was greater in non-CVD deaths than CVD deaths. The percentage of non-CVD deaths increased with hs-CRP levels; among the patients with hs-CRP levels ≥33.3 mg/L, non-CVD deaths accounted for 37.5% of total deaths.ConclusionOur findings suggest that increased hs-CRP is a significant risk factor for inhospital mortality among patients with CVD in an ED. Particular attention should be given to our finding that non-CVD death is a major cause of death among patients with CVD with higher hs-CRP levels.

Predicting in-hospital mortality for patients admitted from the emergency department: An initial alarm score for inpatient care

2020 ◽  
Author(s):  
Ming-Ju Hsieh ◽  
Nin-Chieh Hsu ◽  
Yu-Feng Lin ◽  
Chin-Chung Shu ◽  
Wen-Chu Chiang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Cancer Metastasis ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
Cutoff Value ◽  
Derivation Cohort ◽  
Cox Proportional Hazard Regression

Abstract Background: The in-hospital mortality of patients admitted from the emergency department (ED) is high, but no appropriate initial alarm score is available. Methods: This prospective observational study enrolled ED-admitted patients in hospitalist-care wards and analyzed the predictors for seven-day in-hospital mortality from May 2010 to October 2016. Two-thirds were randomly assigned to a derivation cohort for development of the model and cross-validation was performed in the validation cohort. Results: During the study period, 8,649 patients were enrolled for analysis. The mean age was 71.05 years, and 51.91% were male. The most common admission diagnoses were pneumonia (36%) and urinary tract infection (20.05%). In the derivation cohort, multivariable Cox proportional hazard regression revealed that a low Barthel index score, triage level 1 at the ED, presence of cancer, metastasis, and admission diagnoses of pneumonia and sepsis were independently associated with seven-day in-hospital mortality. Based on the probability developed from the multivariable model, the area under the receiver operating characteristic curve in the derivation group was 0.81 [0.79–0.85]. The result in the validation cohort was comparable. The prediction score modified by the six independent factors had high sensitivity of 88.03% and a negative predictive value of 99.51% for a cutoff value of 4, whereas the specificity and positive predictive value were 89.61% and 10.55%, respectively, when the cutoff value was a score of 6. Conclusion: The seven-day in-hospital mortality in a hospitalist-care ward is 2.8%. The initial alarm score could help clinicians to prioritize or exclude patients who need urgent and intensive care.

scholarly journals High-sensitivity C-reactive protein in chronic low back pain with vertebral end-plate modic signal changes

2007 ◽  
Vol 57 (7) ◽  
pp. 1311-1315 ◽  
Author(s):  
François Rannou ◽  
Walid Ouanes ◽  
Isabelle Boutron ◽  
Bianca Lovisi ◽  
Fouad Fayad ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
High Sensitivity ◽  
Low Back ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
End Plate ◽  
Signal Changes

scholarly journals Perforated Diverticulitis Complicated by Pylephlebitis and Splenic Infarction

2021 ◽  
Author(s):  
Catarina Janicas ◽  
David Campos-Correia ◽  
Ana Paula Vasconcelos
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Lower Back Pain ◽  
Splenic Infarction ◽  
Perforated Diverticulitis ◽  
Analytical Evaluation ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Lower Back ◽  
History Of

64-year-old male presented to our emergency department with a 6-day history of generalized malaise, worsened by left lower back pain and anorexia for the last 2 days. Other symptoms were denied, and analytical evaluation only showed leucocytosis and elevated C-reactive protein. […]

scholarly journals A simple tool to help ruling-out Covid-19 in the emergency department: derivation and validation of the LDH-CRP-Lymphocyte (LCL) score

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Jacopo Davide Giamello ◽  
Giulia Paglietta ◽  
Giulia Cavalot ◽  
Attilio Allione ◽  
Sara Abram ◽  
...  
Keyword(s):  
Validation Cohort ◽  
Negative Likelihood Ratio ◽  
C Reactive Protein ◽  
Derivation Cohort ◽  
Reactive Protein ◽  
Simple Tool ◽  
Lactate Dehydrogenase C ◽  
The Difference ◽  
To Receive ◽  
Rule Out

After the outbreak of the Covid-19 pandemic, cases of SARSCoV- 2 infections may gradually decrease in the next months. Given the reduced prevalence of the disease, Emergency Departments (ED) are starting to receive more and more non- Covid19 patients. Thus, a way to quickly discriminate ED patients with potential Covid-19 infection from non-Covid19 patients is needed in order to keep potentially contagious patients isolated while awaiting second-level testing. In this paper, we present the derivation and validation of a simple, practical, and cheap score that could be helpful to rule out Covid-19 among ED patients with suspicious symptoms (fever and/or dyspnoea). The LCL score was derived from a cohort of 335 patients coming to the ED of our hospital from March 16th to April 1st, 2020. It was then retrospectively validated in a similar cohort of 173 patients admitted to our ED during April. The score is based on blood values of lactate dehydrogenase, C-reactive protein, and lymphocyte count. The LCL score performed well both in the derivation and in the validation cohort, with an AUC respectively of 0.81 (95% CI: 0.77 – 0.86) and of 0.71 (95% CI: 0.63 – 0.78), given the difference in Covid- 19 prevalence between the two cohorts (57% vs 41% respectively). An LCL score equal to 0 had a negative predictive value of 0.92 in the derivation cohort and of 0.81 in the validation cohort, with a negative likelihood ratio respectively of 0.08 and 0.36 for Covid- 19 exclusion. This score could, therefore, constitute a useful tool to help physicians manage patients in the ED.

scholarly journals Chest radiography to assess and prognosticate COVID-19

2020 ◽  
Author(s):  
Terrence Chi Hong Hui ◽  
Hau Wei Khoo ◽  
Barnaby Edward Young ◽  
Sean Wei Xiang Ong ◽  
Salahudeen Mohamed Haja Mohideen ◽  
...  
Keyword(s):  
Chest Radiography ◽  
Scoring System ◽  
Validation Cohort ◽  
Supplemental Oxygen ◽  
C Reactive Protein ◽  
Oxygen Requirement ◽  
Derivation Cohort ◽  
Reactive Protein ◽  
Radiographic Score ◽  
Multicenter Prospective Study

Abstract Background To determine the utility of chest radiography (CXR) for assessing and prognosticating COVID-19 disease with an objective radiographic scoring system.Methods A multicenter, prospective study was conducted, forty patients were included. Seventy-eight CXR’s were performed on the first derivation cohort of twenty patients with COVID-19 (median age 47.5 years, 10 females and four with comorbidities) admitted between 22 January 2020 and 1 February 2020. Each CXR was scored by three radiologists in consensus and graded on a 72-point COVID-19 Radiographic Score (CRS). This was correlated with supplemental oxygen requirement, C-reactive protein (CRP), lactate dehydrogenase (LDH) and lymphocyte count. To validate our findings, the parameters of another validation cohort of twenty patients with 65 CXRs were analysed.Results In the derivation cohort, seven patients needed supplemental oxygen and one was intubated for mechanical ventilation with no death. The maximum CRS was significantly different between patients on and not on supplemental oxygen (p=<.001). There was strong correlation between maximum CRS and lowest oxygen saturation (r= -.849), maximum CRP (r= .832) and maximum LDH (r= .873). These findings were consistent in the validation cohort. An increment of 2 points in CRS had an accuracy of 0.938 with 100.0% sensitivity (95% CI 100.0-100.0) and 83.3% (95% CI 65.1-100.0) specificity in predicting supplemental oxygen requirement.Conclusion Using an objective scoring system (CRS), the degree of abnormalities on CXR correlates closely with known markers of disease severity. CRS may further be applied to predict patients who require oxygen supplementation during the course of their disease.

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