Prognostic Value of Procalcitonin, C-Reactive Protein, and Lactate Levels in Emergency Evaluation of Cancer Patients with Suspected Infection

Cancer patients have increased risk of infections, and often present to emergency departments with infection-related problems where physicians must make decisions based on a snapshot of the patient’s condition. Although C-reactive protein, procalcitonin, and lactate are popular biomarkers of sepsis, their use in guiding emergency care of cancer patients with infections is unclear. Using these biomarkers, we created a prediction model for short-term mortality in cancer patients with suspected infection. We retrospectively analyzed all consecutive patients who visited the emergency department of MD Anderson Cancer Center between 1 April 2018 and 30 April 2019. A clinical decision model was developed using multiple logistic regression for various clinical and laboratory biomarkers; coefficients were used to generate a prediction score stratifying patients into four groups according to their 14-day mortality risk. The prediction score had an area under the receiver operating characteristic curve value of 0.88 (95% confidence interval 0.85–0.91) in predicting 14-day mortality. The prediction score also accurately predicted intensive care unit admission and 30-day mortality. Our simple new scoring system for mortality prediction, based on readily available clinical and laboratory data, including procalcitonin, C-reactive protein, and lactate, can be used in emergency departments for cancer patients with suspected infection.

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C-Reactive Protein Was an Early Predictor of Postoperative Infectious Complications After Pancreaticoduodenectomy for Pancreatic Cancer

International Surgery ◽

10.9738/intsurg-d-16-00171.1 ◽

2017 ◽

Vol 102 (5-6) ◽

pp. 258-266

Author(s):

Yosuke Atsumi ◽

Toru Aoyama ◽

Keisuke Kazama ◽

Masaaki Murakawa ◽

Manabu Shiozawa ◽

...

Keyword(s):

Pancreatic Cancer ◽

Predictive Value ◽

Characteristic Curve ◽

Laboratory Data ◽

Infectious Complications ◽

C Reactive Protein ◽

Study Objective ◽

Reactive Protein ◽

Background Data ◽

Grade Iii

Objective The study objective was to assess the predictive value of C-reactive protein (CRP) for the early detection of postoperative infectious complications (PICs) after pancreaticoduodenectomy. Summary of Background Data The incidence of PICs after pancreaticoduodenectomy still remains high and a clinically relevant problem, despite improvements in the surgical procedure. Methods We examined 110 consecutive patients who underwent pancreaticoduodenectomy for primary pancreatic cancer between 2006 and 2014. The predictive value was assessed by estimating the area under the receiver operating characteristic curve (AUC). Clinical and laboratory data, including CRP, were analyzed with univariate and multivariate logistic regression analyses to identify predictors of PICs of grade III or higher according to the Clavien-Dindo classification. Results PICs of grade III or higher occurred in 13 patients [11.8%; 95% confidence interval (CI), 6.45%–19.36%]. CRP level on postoperative day 3 (POD 3) was a good predictor of PICs (AUC, 0.815; 95% CI, 0.651–0.980), showing the highest accuracy among clinical and laboratory data. A cutoff value of 13.2 mg/dL yielded a sensitivity of 0.846 and a specificity of 0.794. On multivariate analysis, a POD 3 CRP level of 13.2 mg/dL or higher (odds ratio, 20.0; 95% CI, 4.07–97.9; P = 0.002) was a significant predictor of PICs after pancreaticoduodenectomy. Conclusions CRP elevation above 13.2 mg/dL on POD 3 is a significant predictive factor for PICs and should prompt an intense clinical search and therapeutic approach for PICs.

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C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa153 ◽

2020 ◽

Vol 7 (5) ◽

Cited By ~ 38

Author(s):

Guyi Wang ◽

Chenfang Wu ◽

Quan Zhang ◽

Fang Wu ◽

Bo Yu ◽

...

Keyword(s):

Early Stage ◽

Characteristic Curve ◽

Laboratory Data ◽

Area Under The Curve ◽

Threshold Value ◽

Clinical Findings ◽

Optimal Threshold ◽

C Reactive Protein ◽

Related Factors ◽

Reactive Protein

Abstract Background Clinical findings indicated that a fraction of coronavirus disease 2019 (COVID-19) patients diagnosed as mild early may progress to severe cases. However, it is difficult to distinguish these patients in the early stage. The present study aimed to describe the clinical characteristics of these patients, analyze related factors, and explore predictive markers of the disease aggravation. Methods Clinical and laboratory data of nonsevere adult COVID-19 patients in Changsha, China, were collected and analyzed on admission. A logistic regression model was adopted to analyze the association between the disease aggravation and related factors. The receiver operating characteristic curve (ROC) was utilized to analyze the prognostic ability of C-reactive protein (CRP). Results About 7.7% (16/209) of nonsevere adult COVID-19 patients progressed to severe cases after admission. Compared with nonsevere patients, the aggravated patients had much higher levels of CRP (median [range], 43.8 [12.3–101.9] mg/L vs 12.1 [0.1–91.4] mg/L; P = .000). A regression analysis showed that CRP was significantly associated with aggravation of nonsevere COVID-19 patients, with an area under the curve of 0.844 (95% confidence interval, 0.761–0.926) and an optimal threshold value of 26.9 mg/L. Conclusions CRP could be a valuable marker to anticipate the possibility of aggravation of nonsevere adult COVID-19 patients, with an optimal threshold value of 26.9 mg/L.

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Faculty Opinions recommendation of Elevated maternal C-reactive protein and increased risk of schizophrenia in a national birth cohort.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718470282.793502246 ◽

2014 ◽

Author(s):

Driss Moussaoui ◽

Adil Khoubila

Keyword(s):

Birth Cohort ◽

C Reactive Protein ◽

Reactive Protein ◽

Increased Risk

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Relationship between serum angiopoietin-like 4 levels and recurrence of atrial fibrillation

Journal of International Medical Research ◽

10.1177/0300060520988393 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052098839

Author(s):

Zhongping Ning ◽

Xinming Li ◽

Xi Zhu ◽

Jun Luo ◽

Yingbiao Wu

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Operating Characteristic ◽

Characteristic Curve ◽

High Sensitivity ◽

Peroxisome Proliferator ◽

C Reactive Protein ◽

Peroxisome Proliferator Activated Receptor ◽

Reactive Protein ◽

New Onset

Objective To investigate the association between serum angiopoietin-like 4 (ANGPTL4) levels and recurrence of atrial fibrillation (AF) after catheter ablation. Methods This retrospective study recruited patients with AF undergoing catheter ablation and they were divided into two groups (new-onset AF group and recurrent AF group). Demographic, clinical, and laboratory parameters were collected. Results A total of 192 patients with AF were included, including 69 patients with recurrence of AF. Serum ANGPTL4 levels were lower in patients with recurrent AF than in those with new-onset AF. Serum ANGPTL4 levels were positively correlated with superoxide dismutase and peroxisome proliferator-activated receptor γ, and negatively correlated with the CHA2DS2-VASC score, left atrial diameter, and levels of brain natriuretic peptide, malondialdehyde, high-sensitivity C-reactive protein, and interleukin-6. The receiver operating characteristic curve showed that the best cut-off for recurrent AF was serum ANGPTL4 levels < 19.735 ng/mL, with a sensitivity and specificity of 63.9% and 74.5%, respectively. Serum ANGPTL4 levels were significantly associated with recurrence and new onset of AF (odds ratio, 2.241; 95% confidence interval, 1.081–4.648). Conclusions Serum ANGPTL4 levels are lower in patients with recurrent AF than in those with new-onset AF, and are associated with cardiac hypertrophy, oxidative stress, and inflammation.

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Simple Stratification of Survival Using Bone Scan and Serum C-Reactive Protein in Prostate Cancer Patients with Metastases

Urologia Internationalis ◽

10.1159/000112601 ◽

2008 ◽

Vol 80 (2) ◽

pp. 129-133 ◽

Cited By ~ 14

Author(s):

Jun Nakashima ◽

Eiji Kikuchi ◽

Akira Miyajima ◽

Ken Nakagawa ◽

Mototsugu Oya ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Bone Scan ◽

C Reactive Protein ◽

Reactive Protein

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C-Reactive Protein and All-Cause Mortality in a Large Hospital-Based Cohort

Clinical Chemistry ◽

10.1373/clinchem.2007.091959 ◽

2008 ◽

Vol 54 (2) ◽

pp. 343-349 ◽

Cited By ~ 62

Author(s):

Claudia Marsik ◽

Lili Kazemi-Shirazi ◽

Thomas Schickbauer ◽

Stefan Winkler ◽

Christian Joukhadar ◽

...

Keyword(s):

Hospital Admission ◽

Acute Phase ◽

Cox Regression ◽

Disease Risk ◽

C Reactive Protein ◽

Reactive Protein ◽

Increased Risk ◽

All Cause Mortality ◽

Low Sensitivity

Abstract Background: C-reactive protein (CRP), an acute-phase protein, is a sensitive systemic marker of inflammation and acute-phase reactions. Testing CRP concentrations at hospital admission may provide information about disease risk and overall survival. Methods: All first-ever transmittals to the department of medical and chemical laboratory diagnostics for determination of low-sensitivity CRP (n = 274 515, 44.5% male, median age 51 years) between January 1991 and July 2003 were included [median follow-up time: 4.4 years (interquartile range, 2.3–7.4 years)]. The primary endpoint was all-cause mortality. Multivariate Cox regression adjusted for sex and age was applied for analysis. Results: Compared to individuals within the reference category (CRP <5 mg/L), hazard ratios (HR) for all-cause mortality increased from 1.4 (5–10 mg/L category) to 3.3 in the highest category (>80 mg/L, all P <0.001). CRP was associated with various causes of death. The relation of CRP to cancer death was stronger than to vascular death. Younger patients with increased CRP had relatively far worse outcome than older patients (maximal HR: ≤30 years: 6.7 vs >60 years: 1.7–3.7). Interestingly, both short- and long-term mortality were associated with increasing CRP concentrations (>80 mg/L: HR 22.8 vs 1.4). Conclusion: Measurement of low-sensitivity CRP at hospital admission allowed for the identification of patients at increased risk of unfavorable outcome. Our findings indicate that close attention should be paid to hospitalized patients with high CRP not only because of very substantial short-term risk, but also long-term excess risk, the basis for which needs to be determined.

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Serum Lactate Is a Better Predictor of Short-Term Mortality When Stratified by C-reactive Protein in Adult Emergency Department Patients Hospitalized for a Suspected Infection

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2010.10.016 ◽

2011 ◽

Vol 57 (3) ◽

pp. 291-295 ◽

Cited By ~ 23

Author(s):

Jeffrey P. Green ◽

Tony Berger ◽

Nidhi Garg ◽

Nathan I. Shapiro

Keyword(s):

Emergency Department ◽

Serum Lactate ◽

C Reactive Protein ◽

Short Term ◽

Suspected Infection ◽

Reactive Protein ◽

Short Term Mortality ◽

Emergency Department Patients

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The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism

Acute Medicine Journal ◽

10.52964/amja.0655 ◽

2017 ◽

Vol 16 (2) ◽

pp. 52-59

Author(s):

Sotirios Kakavas ◽

◽

Aggeliki Papanikolaou ◽

Evangelos Balis ◽

Evgenios Metaxas ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

C Reactive Protein ◽

Reactive Protein ◽

Risk Of Death ◽

Increased Risk ◽

Preliminary Study ◽

Wbc Count ◽

A Prospective Study ◽

Acute Pe

Our aim was to prospectively assess the prognostic value of beta2- microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. In this preliminary study, baseline b2-M levels significantly correlated with the impairment of oxygenation and with all the parameters that are used for the early risk stratification of patients. In multivariate analysis, patients’ age and baseline b2-M levels were significantly associated with an increased risk of death. These findings require further prospective validation.

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SERUM C-REACTIVE PROTEIN IN INFECTIONS DURING THE FIRST SIX MONTHS OF LIFE

PEDIATRICS ◽

10.1542/peds.37.2.270 ◽

1966 ◽

Vol 37 (2) ◽

pp. 270-277

Author(s):

Natalie S. Felix ◽

Hironori Nakajima ◽

B. M. Kagan

Keyword(s):

Cord Blood ◽

Positive Reaction ◽

Clinical Judgment ◽

C Reactive Protein ◽

Protein Determination ◽

Suspected Infection ◽

Reactive Protein ◽

Blood Specimens ◽

Usual Laboratory ◽

Single Laboratory

Serum C-reactive protein determinations were done on 66 cord blood specimens and on capillary blood specimens of 669 apparently normal infants and 266 infants ill with known or suspected infection during the first 6 months of life. All but one of the cord blood specimens were negative for C-reactive protein. The incidence of positive reactors increased soon after birth with 50% of the normal newborns having positive reactions during the first week of life. This rapidly decreased after this period so that by 1 month to 6 months of age the incidence was only 2%. The intensity of the positive reaction in the majority was only up to 1 mm. Two-thirds of the infants with infection had positive reactions. The more severe the infection the greater the intensity of the positive reaction. C-reactive protein was also present in a variety of conditions besides infections. Serum C-reactive protein determination can be a valuable diagnostic aid in infections during the first 6 months of life when the usual laboratory criteria for infections are often not helpful. However, it has its limitations. Like any other single laboratory test, it must be used in conjunction with critical clinical judgment.

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