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 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.

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 Predicting Success of Two-Stage Exchange for Prosthetic Joint Infection Using C-Reactive Protein/Albumin Ratio

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Cierra S. Hong ◽  
Sean P. Ryan ◽  
Jonathan A. Gabor ◽  
Michael A. Bergen ◽  
Ran Schwarzkopf ◽  
...  
Keyword(s):  
Joint Infection ◽  
Prognostic Scores ◽  
C Reactive Protein ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Total Arthroplasty ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Two-stage exchange is most commonly used for treatment of prosthetic joint infections (PJI) but, this may fail to eradicate infections. C-reactive protein/albumin ratio (CAR) has been used to predict survival and operative success in other surgical subspecialties and so, we assess the association between CAR and reimplantation success during two-stage revision for PJI defined by the Musculoskeletal Infection Society following a primary total hip (THA) or knee (TKA) arthroplasty. From January, 2005 to December, 2015, two institutional databases were queried and patient demographics, antibiotic duration, C-reactive protein, and albumin were collected prior to reimplantation. Two-stage revisions were considered successful if patients were off of antibiotics and did not require a repeat surgery. CAR was available for 79 patients (34 hips and 46 knees) with 61 successful two-stage revisions and 18 failures. The average CAR for patients with successful reimplantation was 1.2 (0.2, 3.0) compared to 1.0 (0.4, 3.2) for treatment failure. However, this was not statistically significant (p=0.766). Therefore, CAR is not applicable in predicting the prognosis of two-stage revisions for PJI in total arthroplasty but other preoperative inflammatory-based prognostic scores should be explored.

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].

scholarly journals C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections

2017 ◽  
Vol 41 (7) ◽  
pp. 1315-1319 ◽  
Author(s):  
Daniel Pérez-Prieto ◽  
María E. Portillo ◽  
Lluís Puig-Verdié ◽  
Albert Alier ◽  
Santos Martínez ◽  
...  
Keyword(s):  
Low Grade ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

scholarly journals A study of C reactive proteins in patients with stable chronic obstructive pulmonary disease

2019 ◽  
Vol 6 (2) ◽  
pp. 227
Author(s):  
Ashok Kumar Gudagunti ◽  
Sudhir Chaudhri
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Correlation Coefficient ◽  
Chronic Obstructive ◽  
C Reactive Protein ◽  
Obstructive Pulmonary Disease ◽  
Baseline Serum ◽  
Protein Levels ◽  
Reactive Protein ◽  
Serum Crp

Background: Whenever there is damage to the tissue or inflammatory process, the hepatocytes synthesize a protein which is an acute phase reactant, and this is the C reactive protein. Studies have shown that serum C reactive protein levels are usually elevated during acute exacerbations of COPD. The objective of this study was studying the baseline serum C reactive protein levels in patients with stable chronic obstructive pulmonary disease.Methods: During the study period, 90 subjects were studied. Out of them, 47 had stable COPD and 43 were without COPD. The subjects were either admitted in indoor wards or were attending OPD of department of tuberculosis and respiratory diseases, Dr. Murari Lal Chest Hospital, G.S.V.M Medical College, Kanpur, Uttar Pradesh, and were recruited if they fulfilled the criteria for inclusion. Informed consent was taken from all study subjects and the study protocol was approved by the board of faculty of medicine.Results: Of the 47 patients in the stable COPD group, 23 were found to be active smokers. Pearson’s correlation coefficient showed that lower limit of serum CRP levels were significantly negatively correlating with 6 MWD (r= -0.707; p=0.0001), FEV1% (r=-0.635; p=0.0001), PaO2 (r=-0.592; p=0.0001), and BMI (r= -0.534; p=0.0001). Pearson’s correlation coefficient showed that upper limit of serum CRP levels were significantly negatively correlating with 6 MWD (r= -0.707; p=0.0001), FEV1% (r= -0.633; p=0.0001), PaO2 (r= -0.61; p=0.001) and BMI (r= -0.520; p=0.0001).Conclusions: The circulating levels of inflammatory marker, baseline serum CRP are significantly elevated in patients with stable chronic obstructive pulmonary disease.

scholarly journals Serum C-Reactive Protein Is Negatively Associated With Olfactory Identification Ability in Older Adults

i-Perception ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 204166952110099
Author(s):  
Ingrid Ekström ◽  
Davide Liborio Vetrano ◽  
Goran Papenberg ◽  
Erika J. Laukka
Keyword(s):  
Statistical Significance ◽  
Population Based ◽  
Rate Of Change ◽  
Odor Identification ◽  
Sensitivity Analyses ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Olfactory Identification ◽  
Olfactory Ability ◽  
Serum Crp

Importance Olfactory deficits are common in aging and associated with several conditions linked to inflammation. A few studies suggest that increased concentration of pro-inflammatory biomarkers may be related to olfactory deficits, but these associations are understudied in population-based samples. Objective To investigate the association between serum concentrations of C-reactive protein (CRP) and olfactory identification level as well as rate of change in aging. Methods We included 1,721 participants (mean age 70.5 years; 61.9% female) with at least two olfactory assessments across the 12-year follow-up. Baseline level and change in odor identification were estimated with linear mixed models as a function of CRP levels, derived from blood plasma at baseline. Results Results indicated a negative dose–response association between CRP level and odor identification scores at baseline, after adjustment for demographic, cognitive, health, and lifestyle factors. CRP levels ranging between 11 and 20 mg/L were significantly related to lower olfactory ability (β = −0.811, 95% confidence interval [CI] [−1.503 to −0.118]; p = .022). Likewise, CRP values above 20 mg/L were related to lower olfactory scores, an association that approached statistical significance (β = −0.996, 95% CI [−2.045 to 0.054]; p = .063). We found no associations between CRP and olfactory change ( ps > .368). Sensitivity analyses showed that associations between CRP and olfaction were confined to younger participants (age ≤72 years) and men ( ps < .034). Conclusions Our findings suggest a negative association between serum CRP levels and olfactory identification ability in aging that may be dependent on age and sex.

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