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.

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.

scholarly journals Association of plasma level of high-mobility group box-1 with necroptosis and sepsis outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hongseok Yoo ◽  
Yunjoo Im ◽  
Ryoung-Eun Ko ◽  
Jin Young Lee ◽  
Junseon Park ◽  
...  
Keyword(s):  
Plasma Levels ◽  
Validation Cohort ◽  
High Mobility ◽  
Kinase Domain ◽  
High Mobility Group ◽  
Rank Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Derivation Cohort ◽  
The Difference

AbstractThe role of high-mobility group box-1 (HMGB1) in outcome prediction in sepsis is controversial. Furthermore, its association with necroptosis, a programmed cell necrosis mechanism, is still unclear. The purpose of this study is to identify the association between the plasma levels of HMGB1 and the severity and clinical outcomes of sepsis, and to examine the correlation between HMGB1 and key executors of necroptosis including receptor-interacting kinase 3 (RIPK3) and mixed lineage kinase domain-like- (MLKL) proteins. Plasma HMGB1, RIPK3, and MLKL levels were measured with the enzyme-linked immunosorbent assay from the derivation cohort of 188 prospectively enrolled, critically-ill patients between April 2014 and December 2016, and from the validation cohort of 77 patients with sepsis between January 2017 and January 2019. In the derivation cohort, the plasma HMGB1 levels of the control (n = 46, 24.5%), sepsis (n = 58, 30.9%), and septic shock (n = 84, 44.7%) groups were significantly increased (P < 0.001). A difference in mortality between high (≥ 5.9 ng/mL) and low (< 5.9 ng/mL) HMGB1 levels was observed up to 90 days (Log-rank test, P = 0.009). There were positive linear correlations of plasma HMGB1 with RIPK3 (R2 = 0.61, P < 0.001) and MLKL (R2 = 0.7890, P < 0.001). The difference in mortality and correlation of HMGB1 levels with RIPK3 and MLKL were confirmed in the validation cohort. Plasma levels of HMGB1 were associated with the severity and mortality attributed to sepsis. They were correlated with RIPK3 and MLKL, thus suggesting an association of HMGB1 with necroptosis.

C-Reactive Protein as A Fungal Infection Marker in Acute Leukemia Patients

2021 ◽  
Vol 27 (2) ◽  
pp. 212
Author(s):  
Brigitte Rina Aninda Sidharta ◽  
JB. Suparyatmo ◽  
Avanti Fitri Astuti
Keyword(s):  
Acute Leukemia ◽  
Predictive Value ◽  
Bacterial Infections ◽  
Fungal Infections ◽  
Lymphoblastic Leukemia ◽  
Negative Likelihood Ratio ◽  
Receiver Operating Curve ◽  
High Morbidity ◽  
C Reactive Protein ◽  
Reactive Protein

Invasive Fungal Infections (IFIs) can cause serious problems in cancer patients and may result in high morbidity andmortality. C-reactive protein levels increase in response to injury, infection, and inflammation. C-reactive protein increasesin bacterial infections (mean of 32 mg/L) and in fungal infections (mean of 9 mg/L). This study aimed to determineC-Reactive Protein (CRP) as a marker of fungal infections in patients with acute leukemia by establishing cut-off values ofCRP. This study was an observational analytical study with a cross-sectional approach and was carried out at the Departmentof Clinical Pathology and Microbiology of Dr. Moewardi Hospital in Surakarta from May until August 2019. The inclusioncriteria were patients with acute leukemia who were willing to participate in this study, while exclusion criteria were patientswith liver disease. There were 61 samples consisting of 30 male and 31 female patients with ages ranging from 1 to 70 years.Fifty-four patients (88.5%) were diagnosed with Acute Lymphoblastic Leukemia (ALL) and 30 (49.18%) were in themaintenance phase. The risk factors found in those patients were neutropenia 50-1500 μL (23.8%), use of intravenous line(22%), and corticosteroid therapy for more than one week (20.9%). The median of CRP in the group of patients with positiveculture results was 11.20 mg/L (11.20-26.23 mg/L) and negative culture results in 0.38 mg/L (0.01-18.63 mg/L). The cut-offvalue of CRP using the Receiver Operating Curve (ROC) was 9.54 mg/L (area under curve 0.996 and p. 0.026), with a sensitivityof 100%, specificity of 93.2%, Positive Predictive Value (PPV) of 33.3%, Negative Predictive Value (PPV) of 100%, PositiveLikelihood Ratio (PLR) of 1.08, Negative Likelihood Ratio (NLR) of 0 and accuracy of 93.4%. C-reactive protein can be used asa screening marker for fungal infections in patients with acute leukemia.

scholarly journals A STUDY TO ASSESS PREDICTIVE ROLE OF C-REACTIVE PROTEIN IN EARLY PREGNANCY AMONG WOMEN

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Neeti Mahla ◽  
Mukesh Choudhary
Keyword(s):  
Early Pregnancy ◽  
Quantitative Estimation ◽  
First Trimester ◽  
Normal Pregnancy ◽  
P Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Predictive Role ◽  
The Difference

Background: To Assess Predictive Role of C-Reactive Protein In Early Pregnancy among Women Methods: Hospital based comparative analysis was conducted on Women with early pregnancy upto 14 weeks with either abdominal pain or vaginal bleeding or suspected extrauterine pregnancy. C-reactive protein (CRP) quantitative estimation is done by turbi-diametric method. Collected samples were sent to a designated lab of our hospital. Results: The mean c-reactive protein level in cases 2.31 with min-max value ranging from 0.80-3.91mg/dl while in controls mean c-reactive protein value came to be 9.12 with min-max range from 3.21-24.16 mg/dl. The difference between the two groups is significant as p value is less than 0.001. Conclusion: Our results of significantly increased CRP levels in normal pregnancy and a clear association between CRP and normal pregnancy, support the clinical application of this diagnostic tool in early pregnancy, especially as a predictor of abnormal first trimester pregnancies. Keywords: CRP, Pregnancy, Women

scholarly journals A novel procalcitonin-based score for detecting sepsis among critically ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245748
Author(s):  
Tung-Lin Tsui ◽  
Ya-Ting Huang ◽  
Wei-Chih Kan ◽  
Mao-Sheng Huang ◽  
Min-Yu Lai ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Validation Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Sepsis Group ◽  
C Reactive Protein ◽  
Multivariate Logistic Regression ◽  
Reactive Protein

Background Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients. Methods We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. Results A total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, “serum PCT level,” “albumin level” and “neutrophil-lymphocyte ratio” at ICU admission, along with “diabetes mellitus,” and “with vasopressor.” We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74–0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69–0.90; sensitivity 0.64; specificity 0.87). Conclusions We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.

scholarly journals Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Paola Lecompte-Osorio ◽  
Steven D. Pearson ◽  
Cole H. Pieroni ◽  
Matthew R. Stutz ◽  
Anne S. Pohlman ◽  
...  
Keyword(s):  
Dead Space ◽  
Validation Cohort ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Separate Analysis ◽  
University Of Chicago ◽  
Derivation Cohort ◽  
Ventilator Mode ◽  
The Difference ◽  
End Tidal

Abstract Purpose In acute respiratory distress syndrome (ARDS), dead space fraction has been independently associated with mortality. We hypothesized that early measurement of the difference between arterial and end-tidal CO2 (arterial-ET difference), a surrogate for dead space fraction, would predict mortality in mechanically ventilated patients with ARDS. Methods We performed two separate exploratory analyses. We first used publicly available databases from the ALTA, EDEN, and OMEGA ARDS Network trials (N = 124) as a derivation cohort to test our hypothesis. We then performed a separate retrospective analysis of patients with ARDS using University of Chicago patients (N = 302) as a validation cohort. Results The ARDS Network derivation cohort demonstrated arterial-ET difference, vasopressor requirement, age, and APACHE III to be associated with mortality by univariable analysis. By multivariable analysis, only the arterial-ET difference remained significant (P = 0.047). In a separate analysis, the modified Enghoff equation ((PaCO2–PETCO2)/PaCO2) was used in place of the arterial-ET difference and did not alter the results. The University of Chicago cohort found arterial-ET difference, age, ventilator mode, vasopressor requirement, and APACHE II to be associated with mortality in a univariate analysis. By multivariable analysis, the arterial-ET difference continued to be predictive of mortality (P = 0.031). In the validation cohort, substitution of the arterial-ET difference for the modified Enghoff equation showed similar results. Conclusion Arterial to end-tidal CO2 (ETCO2) difference is an independent predictor of mortality in patients with ARDS.

scholarly journals Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers

2020 ◽  
Author(s):  
Isabela Nascimento Borges ◽  
Rafael Carneiro ◽  
Rafael Bergo ◽  
Larissa Martins ◽  
Enrico Colosimo ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Critically Ill ◽  
Antibiotic Treatment ◽  
Median Duration ◽  
Critically Ill Patients ◽  
Treatment Time ◽  
C Reactive Protein ◽  
Daily Monitoring ◽  
Reactive Protein ◽  
To Receive

Abstract Background: The rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance . We therefore sought to evaluate the effectiveness of a C reactive protein-based protocol in reducing antibiotic treatment time in critically ill patients.Methods: A randomized, open-label, controlled clinical trial conducted in two intensive care units of a university hospital in Brazil. Critically ill infected adult patients were randomly allocated to: i) intervention to receive antibiotics guided by daily monitoring of CRP levels, and ii) control to receive antibiotics according to the best practices for rational use of antibiotics.Results : 130 patients were included in the CRP (n=64) and control (n=66) groups. In the intention to treat analysis, the median duration of antibiotic therapy for the index infectious episode was 7.0 (5.0-8.8) days in the CRP and 7.0 (7.0-11.3) days in the control (p = 0.011) groups. A significant difference in the treatment time between the two groups was identified in the curve of cumulative suspension of antibiotics, with less exposure in the CRP group (p = 0.007). In the per protocol analysis, involving 59 patients in each group, the median duration of antibiotic treatment was 6.0 (5.0-8.0) days for the CRP and 7.0 (7.0- 10.0) days for the control (p = 0.011) groups. Conclusions: Daily monitoring of CRP levels may aid in the reduction of antibiotic treatment time of critically ill patients, even in a scenario of judicious use of antimicrobials. Trial Registry : ClinicalTrials.gov Identifier: NCT02987790. Registered 09 December 2016, https://clinicaltrials.gov/ct2/show/NCT02987790 .

Abstract P300: C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: Reasons for Geographic and Racial Differences in Stroke (REGARDS)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Kaitlyn M Peper ◽  
Boyi Guo ◽  
Leann Long ◽  
George Howard ◽  
April P Carson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Racial Differences ◽  
Racial Difference ◽  
Incident Diabetes ◽  
Diabetes Incidence ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Difference ◽  
Adjusted Model ◽  
The Impact

Introduction: Black Americans have a higher incidence of diabetes and have elevated inflammatory biomarkers compared to white Americans. Elevated inflammation is a risk factor for diabetes but the impact of inflammation on the racial disparity in diabetes is unknown. Hypothesis: Elevated C-reactive protein (CRP) attenuates the observed black-white difference in incident diabetes. Methods: REGARDS enrolled 30,239 black and white adults aged ≥45 years from the contiguous US in 2003-07. This analysis included REGARDS participants without baseline diabetes who were assessed for diabetes 9 years later. RRs for incident diabetes by race were calculated using modified Poisson regression adjusting for risk factors known to contribute to the racial difference in diabetes incidence. The attenuation by CRP of the black-white RR of incident diabetes was calculated as the percent difference in the race RR in models with and without CRP adjustment; 95% CI for the difference was estimated using bootstrapping. Results: Of 11,073 participants without baseline diabetes (33% black, 67% white), black participants had higher CRP than white participants, and 12.5% developed incident diabetes. The black-white RR for incident diabetes in the base model was 1.74 (95% CI: 1.52, 1.99) for women and 1.44 (1.25, 1.66) for men. Baseline CRP mediated 21% (14, 29%) of this association in women and 20% (12, 34%) in men. These percent attenuations were similar in models adjusting for other diabetes risk factors but were diminished in a fully adjusted model; 5% (-4, 25%) in women and 7% (-43, 50%) in men (Figure). Conclusion: Adjustment for CRP in base models accounted for 20% and 21% of the excess risk of incident diabetes observed in black men and women, respectively, in this study. This substantial mediation persisted after adjusting for other risk factors but was diminished in the fully adjusted model. This suggests a role of inflammation in the diabetogenic effects of risk factors contributing to the observed racial difference in diabetes incidence.

Sign in / Sign up

Export Citation Format

Share Document