Elevated C-reactive protein increases diagnostic accuracy of algorithm-defined stroke-associated pneumonia in afebrile patients

Background and aim Pyrexia-dependent clinical algorithms may under or overdiagnose stroke-associated pneumonia. This study investigates whether inclusion of elevated C-reactive protein as a criterion improves diagnosis. Methods The contribution of C-reactive protein ≥30 mg/l as an additional criterion to a Centers for Disease Control and Prevention-based algorithm incorporating pyrexia with chest signs and leukocytosis and/or chest infiltrates to diagnose stroke-associated pneumonia was assessed in 1088 acute stroke patients from 37 UK stroke units. The sensitivity, specificity, and positive predictive value of different approaches were assessed using adjudicated stroke-associated pneumonia as the reference standard. Results Adding elevated C-reactive protein to all algorithm criteria did not increase diagnostic accuracy compared with the algorithm alone against adjudicated stroke-associated pneumonia (sensitivity 0.74 (95% CI 0.65–0.81) versus 0.72 (95% CI 0.64–0.80), specificity 0.97 (95% CI 0.96–0.98) for both; kappa 0.70 (95% CI 0.63–0.77) for both). In afebrile patients (n = 965), elevated C-reactive protein with chest and laboratory findings had sensitivity of 0.84 (95% CI 0.67–0.93), specificity of 0.99 (95% CI 0.98–1.00), and kappa 0.80 (95% CI 0.70–0.90). The modified algorithm of pyrexia or elevated C-reactive protein and chest signs with infiltrates or leukocytosis had sensitivity of 0.94 (95% CI 0.87–0.97), specificity of 0.96 (95% CI 0.94–0.97), and kappa of 0.88 (95% CI 0.84–0.93) against adjudicated stroke-associated pneumonia. Conclusions An algorithm consisting of pyrexia or C-reactive protein ≥30 mg/l, positive chest signs, leukocytosis, and/or chest infiltrates has high accuracy and can be used to standardize stroke-associated pneumonia diagnosis in clinical or research settings. Trial Registration http://www.isrctn.com/ISRCTN37118456

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Diagnostic Accuracy of C-Reactive Protein in Neonatal Sepsis

Journal of Bioresource Management ◽

10.35691/jbm.4102.0001 ◽

2014 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Sidra Younis ◽

Muhammad Ali Sheikh ◽

Amjad Ali Raza

Keyword(s):

Blood Culture ◽

Diagnostic Accuracy ◽

Neonatal Sepsis ◽

High Sensitivity ◽

Operational Definition ◽

C Reactive Protein ◽

Capillary Refill ◽

Neonatal Deaths ◽

Reactive Protein ◽

Sensitivity Specificity

Sepsis is the most common cause of neonatal mortality and is responsible for 30-50% of total neonatal deaths each year in developing countries. The objective of the study was to determine the diagnostic accuracy of Creactive protein (CRP) in neonatal sepsis. Fifty nine consecutive patients with risk factors and clinical features suggestive of CRP sepsis were selected as per operational definition and fulfilling the inclusion and exclusion criteria. Detailed physical examination was carried out. Blood sample for culture and CRP was taken from all the patients. Results of blood culture and CRP were noted down in the performa. Statistical analysis was performed by SPSS software version 16. Among selected patients 31/59 (52.5%) were male whereas 28/59 (47.5%) were female. Mean age of all patients was 15.47+7.26 days and mean weight was 2.94+0.63Kg. Temperature instability was present in 79.7%, Tachypnea in 69.5%, Tachycardia in 66.1%, delayed capillary refill in 64.4% and oliguria in 55.9%. Blood cultures were positive in 64.4% and raised CRP was found in 64.5%. Sensitivity, specificity, positive predictive value and negative predictive of raised CRP was found to be 97.3%, 95.2%, 97.3% and 95.2% respectively. In conclusion this study show that C-reactive protein has high sensitivity and specificity for establishing the diagnosis of neonatal sepsis which is comparable to that of blood culture results.

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Diagnostic Role of C- Reactive protein in Acute Appendicitis

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i4.31107 ◽

2020 ◽

Vol 16 (4) ◽

pp. 246-251

Author(s):

Ashis Pun ◽

Amit Dhungana ◽

Ramjee Bastola

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

White Blood Count ◽

Negative Appendectomy ◽

C Reactive Protein ◽

Accuracy Rate ◽

Reactive Protein ◽

Diagnostic Role ◽

Sensitivity Specificity

Introduction: Acute appendicitis is the common surgical disease however, accurate diagnosis and exclusion of acute appendicitis always remains challenge to the surgeons. Although diagnoses rely mostly on clinical examination but C- reactive protein (CRP) can be of valuable armamentarium. Hence, this study was conducted to find the diagnostic role of C-reactive protein in Acute Appendicitis Methods: A retrospective cross sectional study was conducted among 100 respondents in the Department of Surgery, Bharatpur Hospital from September 2019 to August 2020. Ethical approval was taken from the Institutional Review Committee (IRC) Bharatpur Hospital. Statistical analysis was done by using SPSS version 16 using descriptive statistics. Results: Total of 100 patients was included in study with mean age 31 years old.Out of which 60% were male and 40% were female. CRP value was raised (>6) in 87 (87%) cases and normal in 13(13%) cases. Among those with raised CRP, three patients had normal appendix histopathologically and 57 had uncomplicated appendicitis and 27 had complicated appendicitis histopathologically with sensitivity, specificity, positive predictive value and diagnostic accuracy rate of 95.45 %, 75 %, 96.55 % and 93% respectively. When white blood count (WBC) and CRP level were combined with HPE findings, its sensitivity, specificity and diagnostic accuracy rate were 100%, 80% and 93.83 % respectively. Conclusions: CRP improves the diagnostic accuracy of Acute appendicitis. The adjunct use of CRP and leucocyte count can effectively reduce the negative appendectomy rate.

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Post-operative serum procalcitonin vs C reactive Protein as a marker of post-operative infectious complications in pancreatic surgery – A systemic review and meta-analysis

10.1101/2020.10.06.20208181 ◽

2020 ◽

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Diagnostic Accuracy ◽

Odds Ratio ◽

Area Under Curve ◽

Pancreatic Surgery ◽

Meta Analysis ◽

Diagnostic Odds Ratio ◽

Infectious Complications ◽

C Reactive Protein ◽

Reactive Protein ◽

Sensitivity Specificity

AbstractAim of StudyAim of this meta-analysis was to compare diagnostic accuracy of C reactive Protein and Procalcitonin between postoperative day 3 to 5 in predicting infectious complications post pancreatic surgery.MethodsSystemic literature search was performed using MEDLINE, EMBASE and SCOPUS to identify studies evaluating the diagnostic accuracy of Procalcitonin (PCT) and C-Reactive Protein (CRP) as a predictor for detecting infectious complications between postoperative days (POD) 3 to 5 following pancreatic surgery. A meta-analysis was performed using random effect model and pooled predictive parameters. Geometric means were calculated for PCT cut offs. The work has been reported in line with PRISMA guidelines.ResultsAfter applying inclusion and exclusion criteria 15 studies consisting of 2212 patients were included in the final analysis according to PRISMA guidelines. Pooled sensitivity, specificity, Area under curve and diagnostic odds ratio (DOR)for day 3 C-reactive protein was respectively 62%,67% 0.772 and 6.54. Pooled sensitivity, specificity, Area under curve and diagnostic odds ratio (DOR)for day 3 procalcitonin was respectively 74%,79%,0.8453 and 11.03. Sensitivity, specificity, Area under curve, and Diagnostic odds ratio for day 4 C-reactive protein was respectively 60%,68%, 0.8022 and 11.90. Pooled Sensitivity, specificity and Diagnostic odds ratio of post-operative day 5 procalcitonin level in predicting infectious complications were respectively 83%,70% and 12.9. Pooled Sensitivity, specificity, AUROC and diagnostic odds ratio were respectively 50%,70%, 0.777 and 10.19.ConclusionPost-operative procalcitonin is better marker to predict post-operative infectious complications after pancreatic surgeries and post-operative day 3 procalcitonin has highest diagnostic accuracy.

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DIAGNOSTIC ACCURACY OF PRESEPSIN, PROCALCITONIN, AND HIGH SENSITIVE C-REACTIVE PROTEIN AS BIOMARKERS FOR EARLY DIAGNOSIS OF PAEDIATRIC SEPSIS USING THE BIOSCORE MODEL

10.26226/morressier.58fa1768d462b80290b517da ◽

2017 ◽

Author(s):

Samuel Sakyi

Keyword(s):

Early Diagnosis ◽

Diagnostic Accuracy ◽

C Reactive Protein ◽

Reactive Protein

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Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of infectious complications after colorectal surgery

International Journal of Colorectal Disease ◽

10.1007/s00384-011-1376-4 ◽

2011 ◽

Vol 27 (9) ◽

pp. 1237-1237 ◽

Cited By ~ 2

Author(s):

Pablo Ortega-Deballon ◽

Olivier Facy ◽

Patrick Rat

Keyword(s):

Colorectal Surgery ◽

Early Detection ◽

Blood Cell ◽

Diagnostic Accuracy ◽

Infectious Complications ◽

C Reactive Protein ◽

Reactive Protein ◽

Cell Counts ◽

Blood Cell Counts ◽

White Blood Cell Counts

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Diagnostic accuracy of serum inflammatory markers in late fracture-related infection

The Bone & Joint Journal ◽

10.1302/0301-620x.100b12.bjj-2018-0586.r1 ◽

2018 ◽

Vol 100-B (12) ◽

pp. 1542-1550 ◽

Cited By ~ 13

Author(s):

J. van den Kieboom ◽

P. Bosch ◽

J. D. J. Plate ◽

F. F. A. IJpma ◽

R. Kuehl ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Inflammatory Markers ◽

Meta Analysis ◽

Diagnostic Value ◽

Mixed Effects Models ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Serum Inflammatory Markers

Aims To assess the diagnostic value of C-reactive protein (CRP), leucocyte count (LC), and erythrocyte sedimentation rate (ESR) in late fracture-related infection (FRI). Materials and Methods PubMed, Embase, and Cochrane databases were searched focusing on the diagnostic value of CRP, LC, and ESR in late FRI. Sensitivity and specificity combinations were extracted for each marker. Average estimates were obtained using bivariate mixed effects models. Results A total of 8284 articles were identified but only six were suitable for inclusion. Sensitivity of CRP ranged from 60.0% to 100.0% and specificity from 34.3% to 85.7% in all publications considered. Five articles were pooled for meta-analysis, showing a sensitivity and specificity of 77.0% and 67.9%, respectively. For LC, this was 22.9% to 72.6%, and 73.5% to 85.7%, respectively, in five articles. Four articles were pooled for meta-analysis, resulting in a 51.7% sensitivity and 67.1% specificity. For ESR, sensitivity and specificity ranged from 37.1% to 100.0% and 59.0% to 85.0%, respectively, in five articles. Three articles were pooled in meta-analysis, showing a 45.1% sensitivity and 79.3% specificity. Four articles analyzed the value of combined inflammatory markers, reporting an increased diagnostic accuracy. These results could not be pooled due to heterogeneity. Conclusion The serum inflammatory markers CRP, LC, and ESR are insufficiently accurate to diagnose late FRI, but they may be used as a suggestive sign in its diagnosis.

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The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609957371 ◽

2013 ◽

Vol 95 (3) ◽

pp. 215-221 ◽

Cited By ~ 28

Author(s):

I G Panagiotopoulou ◽

D Parashar ◽

R Lin ◽

S Antonowicz ◽

AD Wells ◽

...

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Cell Count ◽

Inflammatory Markers ◽

White Cell Count ◽

Perforated Appendicitis ◽

Diagnostic Value ◽

White Cell ◽

C Reactive Protein ◽

Reactive Protein

Introduction Inflammatory markers such as white cell count (WCC) and C-reactive protein (CRP) and, more recently, bilirubin have been used as adjuncts in the diagnosis of appendicitis. The aim of this study was to determine the diagnostic accuracy of the above markers in acute and perforated appendicitis as well as their value in excluding the condition. Methods A retrospective analysis of 1,169 appendicectomies was performed. Patients were grouped according to histological examination of appendicectomy specimens (normal appendix = NA, acute appendicitis = AA, perforated appendicitis = PA) and preoperative laboratory test results were correlated. Receiver operating characteristic (ROC) curve area analysis (area under the curve [AUC]) was performed to examine diagnostic accuracy. Results ROC analysis of all laboratory variables showed that no independent variable was diagnostic for AA. Good diagnostic accuracy was seen for AA when all variables were combined (WCC/CRP/bilirubin combined AUC: 0.8173). In PA, the median CRP level was significantly higher than that of AA (158mg/l vs 30mg, p<0.0001). CRP also showed the highest sensitivity (100%) and negative predictive value (100%) for PA. CRP had the highest diagnostic accuracy in PA (AUC: 0.9322) and this was increased when it was combined with WCC (AUC: 0.9388). Bilirubin added no diagnostic value in PA. Normal levels of WCC, CRP and bilirubin could not rule out appendicitis. Conclusions CRP provides the highest diagnostic accuracy for PA. Bilirubin did not provide any discriminatory value for AA and its complications. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis.

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Differences in C-Reactive Protein (CRP) between depression levels in ischaemic stroke patients

Stem Cell Oncology ◽

10.1201/9781351190152-18 ◽

2018 ◽

pp. 81-85

Author(s):

S.N. Lubis ◽

W.H. Lubis ◽

I. Nasution

Keyword(s):

Ischaemic Stroke ◽

C Reactive Protein ◽

Stroke Patients ◽

Reactive Protein

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Clinical predictive efficacy of C-reactive protein for diagnosing infectious complications after gastric surgery

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820936542 ◽

2020 ◽

Vol 13 ◽

pp. 175628482093654

Author(s):

Jinyao Shi ◽

Zhouqiao Wu ◽

Qi Wang ◽

Yan Zhang ◽

Fei Shan ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Anastomotic Leakage ◽

Enhanced Recovery ◽

Gastric Surgery ◽

Infectious Complications ◽

C Reactive Protein ◽

Characteristic Analysis ◽

Training Set ◽

Reactive Protein ◽

Validation Set

Background: With the popularization of Enhanced Recovery After Surgery (ERAS), identifying patients with complications before discharging becomes important. This study aimed to explore the efficacy of C-reactive protein (CRP) in predicting infectious complications after gastrectomy. Methods: Patients with gastric cancer who underwent gastrectomy at Beijing Cancer Hospital from March 2017 to April 2018 were enrolled in the training set. Complications were prospectively registered. Receiver operating characteristic analysis was performed to assess the diagnostic accuracy of CRP via evaluating the area under the curve (AUC). Patients who had CRP tested on postoperative day (POD) 5 and accepted gastrectomy from April to December 2018 were included in the validation set to validate the cut-off value of CRP obtained from the training set. Results: A total of 350 patients were included (263 patients in the training set and 87 patients in the validation set). Out of these, 24 patients were diagnosed with infectious complications and 17 patients had anastomotic leakage in the training set. The CRP level on POD5 had superior diagnostic accuracy for infectious complications with an AUC of 0.81. The cut-off value of CRP on POD5 at 166.65 mg/L yielded 93% specificity and 97.2% negative predict value (NPV); For anastomotic leakage, the AUC of CRP on POD5 was 0.81. Using the cut-off value of CRP at 166.65 mg/L on POD5 achieved 92% specificity and 98.6% NPV. The optimal cut-off value (CRP 166.65 mg/L on POD5) was validated in the validation set. It achieved 97.5% specificity and 94.0% NPV for infectious complications, and 97.6% specificity and 96.4% NPV for anastomotic leakage. Conclusion: CRP is a reliable predictive marker for the diagnosis of inflammatory complications following gastric surgery. However, this study was based on preliminary data. The validity of this data needs confirmation by a larger number of cases.

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