Serum C-Reactive Protein in the Rapid Diagnosis of Bacterial Infection during Sickle Cell Crisis: A Preliminary Report

Bacterial infection is an important trigger of vaso-occlusive crisis (VOC) in sickle cell anaemia (SCA). SCA Patients with VOC have signs of inflammation and it is difficult to diagnose bacterial infection in them. This study was undertaken to evaluate serum procalcitonin (PCT) as a biomarker of bacterial infection in acute sickle cell vaso-occlusive crisis. Hundred SCA patients were studied at Sickle Cell Clinic and Molecular Biology Laboratory, V.S.S. Medical College, Burla, Odisha, India. SCA was diagnosed by haemoglobin electrophoresis, HPLC and molecular analysis. Patients were divided into 3categories namely Category-A (VOC/ACS with fever but without evidence of bacterial infection-66 patients); Category-B (VOC with fever and documentedbacterial infection-24 patients); and Category-C (Patients in steady statewithout VOC/ACS or fever-10 patients). Investigations like complete blood count, C-reactive protein estimation and PCT measurement was done in all the cases. There was no significant difference in total leucocytes count and C-reactiveprotein values between category A and B. In category A the PCT level was <0.5ng/mL in 83.3% and 0.5-2ng/mL in 16.7% of cases. In category B all the cases had PCT value >0.5ng/mL with 87.5% of cases having >2ng/mL. In category C, PCT value was <0.5ng/mL. The PCTvalue differed significantly (p<0.0001) in three categories. PCT had a highsensitivity (100%) and negative predictive value (100%) for bacterial infection at a cut-off value of 0.5ng/mL; whereas the specificity is excellent at a cutoff value of 2ng/mL. SCA patients with VOC/ACS with fever presenting with a PCT level of <0.5ng/mL do not have bacterial infection. In patients with VOC/ACS and fever, PCT value of >2ng/mL is indicative of bacterial infection necessitating antimicrobial therapy. Patients with indeterminate PCT value of0.5-2ng/mL, need a repeat PCT estimation or an empirical antibiotic therapyawaiting the availability of microbiological report as deemed necessary.

Download Full-text

Serum C-reactive protein and neutrophil-to-lymphocyte ratio as predictors of survival in cirrhotic patients with systemic inflammatory response syndrome and bacterial infection

Indian Journal of Gastroenterology ◽

10.1007/s12664-020-01134-8 ◽

2021 ◽

Author(s):

Ashishkumar Tapadia ◽

Mayank Jain ◽

Mettu Srinivas Reddy ◽

B. Mahadevan ◽

Joy Varghese ◽

...

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Bacterial Infection ◽

Systemic Inflammatory Response ◽

Neutrophil To Lymphocyte Ratio ◽

C Reactive Protein ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Cirrhotic Patients

Download Full-text

Post-operative kinetics of C-reactive protein to distinguish between bacterial infection and systemic inflammation in infants after cardiopulmonary bypass surgery: the early and the late period

Cardiology in the Young ◽

10.1017/s1047951121003231 ◽

2021 ◽

pp. 1-8

Author(s):

Hanna Renk ◽

David Grosse ◽

Sarah Schober ◽

Christian Schlensak ◽

Michael Hofbeck ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Bacterial Infection ◽

Congenital Heart ◽

Bypass Surgery ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

C Reactive Protein ◽

Reactive Protein ◽

Post Operative Period ◽

Kinetics Of

Abstract Objectives: Differentiation between post-operative inflammation and bacterial infection remains an important issue in infants following congenital heart surgery. We primarily assessed kinetics and predictive value of C-reactive protein for bacterial infection in the early (days 0–4) and late (days 5–28) period after cardiopulmonary bypass surgery. Secondary objectives were frequency, type, and timing of post-operative infection related to the risk adjustment for congenital heart surgery score. Methods: This 3-year single-centre retrospective cohort study in a paediatric cardiac ICU analysed 191 infants accounting for 235 episodes of CPBP surgery. Primary outcome was kinetics of CRP in the first 28 days after CPBP surgery in infected and non-infected patients. Results: We observed 22 infectious episodes in the early and 34 in the late post-operative period. CRP kinetics in the early post-operative period did not accurately differentiate between infected and non-infected patients. In the late post-operative period, infected infants displayed significantly higher CRP values with a median of 7.91 (1.64–22.02) and 6.92 mg/dl (1.92–19.65) on days 2 and 3 compared to 4.02 (1.99–15.9) and 3.72 mg/dl (1.08–9.72) in the non-infection group. Combining CRP on days 2 and 3 after suspicion of infection revealed a cut-off of 9.47 mg/L with an acceptable predictive accuracy of 76%. Conclusions: In neonates and infants, CRP kinetics is not useful to predict infection in the first 72 hours after CPBP surgery due to the inflammatory response. However, in the late post-operative period, CRP is a valuable adjunctive diagnostic test in conjunction with clinical presentation and microbiological diagnostics.

Download Full-text