Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

ABSTRACT Introduction Serum C-reactive protein (CRP) and D-lactate have been proposed as markers of intestinal ischemia. The purpose of this prospective observational study is to find whether serum CRP and serum D-lactate can help in predicting strangulation in cases of acute intestinal obstruction. Materials and methods A total of 50 consecutive patients were included in the study after excluding patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and D-lactate were measured and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn and cutoff values for the diagnosis of strangulation were calculated along with calculation of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs). Results A total of 14 patients who were diagnosed with strangulated bowel obstruction had significantly higher values of serum CRP and D-lactate when compared with 36 patients with simple bowel obstruction (116 vs 40 mg/L and 5.4 vs 2.7 mmol/L respectively, p < 0.05). Using ROC analysis, the area under the curve of serum CRP and D-lactate was found to be 0.785 and 0.775 respectively, for bowel strangulation. Using a cutoff value of 60 mg/L for CRP, the sensitivity, specificity, PPV, and NPV were 87.5, 58.3, 48.3, 91.3% respectively. Using a cutoff value of 4.5 mmol/L for D-lactate, the sensitivity, specificity, PPV, and NPV were 75.0, 69.4, 52.7, 86.2% respectively. Conclusion Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting. How to cite this article Pal AK, Ansari MM, Islam N. Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction. Panam J Trauma Crit Care Emerg Surg 2016;5(3):134-139.

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A prospective study of serum C-reactive protein and D-lactate levels for early prediction of strangulation in intestinal obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20192983 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2510

Author(s):

Ramprasad Dhoon ◽

Suresh Kumawat ◽

M. L. Soni ◽

M. K. Rohella ◽

Sunil Sharma ◽

...

Keyword(s):

Intestinal Obstruction ◽

Prospective Study ◽

Acute Intestinal Obstruction ◽

Emergency Laparotomy ◽

Emergency Setting ◽

C Reactive Protein ◽

Cutoff Value ◽

Reactive Protein ◽

Test Sensitivity ◽

Lactate Levels

Background: Intestinal obstruction is one of the commonest clinical problems encountered in surgical practice. One of the grave complications of intestinal obstruction is strangulation, which requires an emergency laparotomy for management. This study was conducted to emphasise the significance of early estimation of rise in serum C-reactive protein and D- lactate levels.Methods: Hospital based prospective study was performed on 50 patients admitted in J.L.N. Hospital, Ajmer in various surgical units with diagnosis of acute intestinal obstruction and underwent explorative Laparotomy.Results: CRP test sensitivity was 85.00%, specificity was 80.67%, PPV was 73.91% and NPV was 88.89% to detected the obstruction with strangulation when using a cutoff value of 60 mg/L. D-lactate test sensitivity was 80.00%, specificity was 90.00%, PPV was 84.30% and NPV was 87.10% to detected the obstruction with strangulation when using a cutoff value of 4.5 mmol/L.Conclusions:Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

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CORRELATION OF SERUM CRP & LACTATE AS AN EARLY PREDICTOR OF STRANGULATION IN ACUTE ABDOMEN

Era s journal of medical research ◽

10.24041/ejmr2020.31 ◽

2020 ◽

Vol 7 (2) ◽

pp. 181-188

Author(s):

Saleem Tahir ◽

Samaksh Giri ◽

Shadab Asif ◽

Brijesh Rathore

Keyword(s):

Acute Abdomen ◽

Diagnostic Value ◽

Serum Lactate ◽

C Reactive Protein ◽

Predictive Values ◽

Cutoff Value ◽

Reactive Protein ◽

Sensitivity Specificity ◽

Serum Crp ◽

Early Predictor

Strangulation in acute abdomen is one of the dangerous complication in patients of acute abdomen and early diagnosis is necessary for prevention of mortality. Present study was aimed to find whether serum C-Reactive Protein (CRP) and Serum Lactate can be used as early predictor for strangulation in cases of acute abdomen. A total of 75 patients with acute abdomen were included in the study. The serum CRP and Lactate values were measured preoperatively and correlated with intraop findings postoperatively. ROC curve was drawn and cutoff value for prediction of strangulation and mortality based on which diagnostic value was calculated. At cutoff level of 45.5 mg/L, CRP was 85.0% sensitive and 85.7% specific with positive and negative predictive values of 87.2% & 83.3% for prediction of strangulation in acute abdomen while sensitivity, specificity, PPV and NPV of Serum lactate was 100.0%, 91.4% 93.0% & 100.0% respectively using cutoff value ≥23.5mg/dl. Serum CRPand Lactate could be useful markers in predicting strangulation in cases of acute abdomen.

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C-reactive protein as a predictor of meningitis in early onset neonatal sepsis: a single unit experience

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0420 ◽

2020 ◽

Vol 48 (8) ◽

pp. 845-851 ◽

Cited By ~ 1

Author(s):

Naveed Ur Rehman Durrani ◽

Sourabh Dutta ◽

Niels Rochow ◽

Salhab el Helou ◽

Enas el Gouhary

Keyword(s):

Early Onset ◽

Neonatal Intensive Care ◽

C Reactive Protein ◽

Likelihood Ratios ◽

Predictive Values ◽

Reactive Protein ◽

Early Onset Sepsis ◽

Polymerase Chain ◽

Sensitivity Specificity ◽

Serum Crp

AbstractObjectivesTo determine whether there is a cut off value of serum C-reactive protein (CRP) associated with a higher risk of meningitis in suspected early onset sepsis (EOS) (onset birth to 7 days of life).MethodsA retrospective cohort study on neonates admitted in neonatal intensive care unit at McMaster Children’s Hospital from January 2010 to 2017 and had lumbar puncture (LP) and CRP for workup of EOS. Included subjects had either (a) non-traumatic LP or (b) traumatic LP with cerebral spinal fluid (CSF) polymerase chain reaction or gram stain or culture-positive or had received antimicrobials for 21 days. Excluded were CSF done for metabolic errors, before cytomegalovirus (CMV) treatment; from ventriculo-peritoneal (VP) shunts; missing data and contamination. Neonates were classified into definite and probable meningitis and on the range of CRP. We calculated sensitivity, specificity, and likelihood ratios for CRP values; and area under the receiver operating characteristic (AUROC) curve.ResultsOut of 609 CSF samples, 184 were eligible (28 cases of definite or probable meningitis and 156 controls). Sensitivity, specificity, predictive values, likelihood ratios, and AUROC were too low to be of clinical significance to predict meningitis in EOS.ConclusionsSerum CRP values have poor discriminatory power to distinguish between subjects with and without meningitis, in symptomatic EOS.

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Role Of C-Reactive Protein in Diagnosis of Acute Appendicitis

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v10i4.660 ◽

2021 ◽

Vol 10 (4) ◽

pp. 210-214

Author(s):

Mirza Tassawar Hussain ◽

Muhammad Kashif Khan ◽

Syed Shamsuddin ◽

Aabid Ali ◽

Erum Khan ◽

...

Keyword(s):

Acute Appendicitis ◽

Correct Diagnosis ◽

C Reactive Protein ◽

Diagnostic Dilemma ◽

Senior Registrar ◽

Predictive Values ◽

Reactive Protein ◽

Highly Sensitive ◽

Sensitivity Specificity

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis. Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23. Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively. Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.

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Preoperative serum C-reactive protein concentration can be used to detect gallbladder rupture in dogs with gallbladder mucocele

American Journal of Veterinary Research ◽

10.2460/ajvr.21.09.0141 ◽

2022 ◽

pp. 1-10

Author(s):

Makoto Asakawa ◽

Mayuko Fukuzawa ◽

Midori Goto Asakawa ◽

James A. Flanders

Keyword(s):

Medical Records ◽

Protein Concentration ◽

Interquartile Range ◽

C Reactive Protein ◽

Abdominal Ultrasonography ◽

Reactive Protein ◽

Preoperative Serum ◽

Sensitivity Specificity ◽

Serum Crp ◽

Gallbladder Rupture

Abstract OBJECTIVE To determine whether serum C-reactive protein (CRP) concentration could be used to detect gallbladder rupture (GBR) prior to surgery in dogs undergoing cholecystectomy for treatment of gallbladder mucocele (GBM). ANIMALS 45 dogs that underwent cholecystectomy because of GBM at a companion animal referral hospital from 2017 to 2020. PROCEDURES Electronic medical records were reviewed, and dogs were included if serum CRP concentration had been measured within 24 hours prior to cholecystectomy. Dogs were grouped as to whether the gallbladder was found to be ruptured or intact during surgery. Accuracy of using preoperative CRP concentration to predict GBR was compared with accuracy of abdominal ultrasonography and other preoperative blood tests. RESULTS GBR was present in 15 dogs at the time of surgery. Median preoperative CRP concentration was significantly higher in dogs with GBR (15.1 mg/dL; interquartile range, 7.4 to 16.8 mg/dL) than in dogs with an intact gallbladder (2.65 mg/dL; interquartile range, 0.97 to 13.4 mg/dL). Sensitivity, specificity, and accuracy of using preoperative CRP concentration to predict GBR were 100%, 67%, and 78%, respectively. CLINICAL RELEVANCE Measurement of preoperative CRP concentration provided excellent sensitivity and moderate specificity for detection of GBR in dogs undergoing cholecystectomy because of GBM. Accuracy of using preoperative CRP concentration for detection of GBR was not superior to the accuracy of preoperative abdominal ultrasonography. However, when CRP concentration was combined with results of ultrasonography, the sensitivity, specificity, and accuracy for detection of GBR were 100%, 93%, and 96%, respectively.

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MP48: White blood cells count and C-reactive protein performance to identify severe bacterial infection in the fever without a source workup of infants 22 to 60 days old

CJEM ◽

10.1017/cem.2019.183 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S59-S60

Author(s):

G. Gravel ◽

K. Vachon ◽

M. Giguère ◽

L. Lajeunesse ◽

J. Morin ◽

...

Keyword(s):

Blood Cells ◽

Bacterial Infections ◽

White Blood Cells ◽

Added Value ◽

Quebec City ◽

C Reactive Protein ◽

Blood Biomarkers ◽

Predictive Values ◽

Reactive Protein ◽

Sensitivity Specificity

Introduction: Identification of severe bacterial infections (SBI) among infants presenting to the emergency department (ED) for fever without a source (FWS) remains challenging. Controversies persist on the usefulness of blood biomarkers, especially when used for assessing infants 22 to 60 days old. Although C-reactive protein (CRP) and white blood cells count (leucocytes) are commonly prescribed, this practice relies on poor and conflicting evidence. Our objective was to determine the performance of those two markers at identifying SBI. Methods: This is a sub-analysis of an ongoing retrospective cohort study conducted in an academic pediatric ED in Quebec City, that aims to determine whether a lumbar puncture should routinely be performed in the FWS workup of 22 to 60 days old infants. All consecutive charts of eligible febrile infants were reviewed. Premature infants (<37 weeks), as well as infants with chronic diseases, immunodeficiency, previous antimicrobial therapy, in-dwelling catheters, or septic shock were excluded. Among others, data related to final diagnosis and investigations were gathered. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios were estimated for each blood biomarkers. Results: Out of 1261 charts reviewed, 920 patients were included in this analysis. SBI prevalence was 13.0% (95%CI: 10.9-15.2) among infants of our cohort. The sensitivity, specificity, PPV, NPV, LR+ and LR- of the leucocytes <5000 or≥15000/□L were 43% (95%CI: 34-53%), 80% (95%CI: 77-83%), 25% (95%CI: 21-30%), 90% (95%CI: 88-91%), 2.1 (95%CI: 1.7-2.8), and 0.72 (95%CI: 0.61-0.84), respectively. The sensitivity, specificity, PPV and NPV of CRP >= 25 mg/L were 46% (95%CI: 37-56%), 96% (95%CI: 94-97%), 65% (95%CI: 55-73%), and 91% (95%CI: 89-92%), respectively. ROC curves analysis indicates that a CRP≥25 mg/L offers the best LR+ (10.4; 95%CI: 6.9-15.6) with a corresponding LR- of 0.56 (95%CI: 0.47-0.67). Conclusion: When evaluating febrile infants in the ED, leucocytes appear to have limited added value, while CRP≥25 mg/L significantly increases the pre-test probability of SBI. CRP should be considered for inclusion in the workup of FWS for infants of 22 to 60 days of age.

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Erythrocyte sedimentation rate and C-reactive protein compared in the elderly.

Clinical Chemistry ◽

10.1093/clinchem/35.3.466 ◽

1989 ◽

Vol 35 (3) ◽

pp. 466-468 ◽

Cited By ~ 11

Author(s):

P R Katz ◽

S I Gutman ◽

G Richman ◽

J Karuza ◽

W R Bartholomew ◽

...

Keyword(s):

Erythrocyte Sedimentation Rate ◽

Sedimentation Rate ◽

Operating Characteristic ◽

Characteristic Curve ◽

The Elderly ◽

C Reactive Protein ◽

Predictive Values ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Sensitivity Specificity

Abstract The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) concentrations were studied in 101 elderly individuals (mean age 72 y) to determine their utility as diagnostic aids in subjects with underlying infection/inflammation. Whereas ESR and CRP were both significantly increased in patients with infection or inflammation, or both, analysis of variance indicated that those subjects still alive six months later had significantly lower ESR values. Analysis of sensitivity, specificity, and positive predictive values indicated that neither test satisfactorily discriminated between patients with and those without ongoing active or chronic disease. Receiver-operating characteristic curve analysis confirmed the low true-positive/false-positive ratios of both ESR and CRP. In the elderly, neither CRP nor ESR has distinct advantages over the other, and both tests evidently have limited utility.

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Study of C - reactive protein in neonatal sepsis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171693 ◽

2017 ◽

Vol 4 (3) ◽

pp. 890

Author(s):

Gunjan Mehrotra

Keyword(s):

Blood Culture ◽

Neonatal Sepsis ◽

Tertiary Care ◽

Signs And Symptoms ◽

The Body ◽

Causative Organism ◽

C Reactive Protein ◽

Predictive Values ◽

Reactive Protein ◽

Sensitivity Specificity

Background: Sepsis is one of the most common causes of morbidity and mortality in the newborn. Early diagnosis and treatment is vital to improve outcome. Neonatal sepsis in newborn is characterized by paucity of signs and symptoms and is due to invasion and spread through the body of non-pathogenic/ pathogenic & Gram positive / negative organism. It is subtle disease, the general characteristic of bacterial infection in neonatal period are influenced more by response of the infant than the causative organism. The present study was therefore carried out to determine the usefulness of C-reactive protein (CRP) for evaluation of neonatal sepsis in tertiary care hospital.Methods: Neonates with clinical suspicion of sepsis were prospectively studied out from June 2006 to January 2008. Blood was obtained from each subject recruited for the qualitative estimation of CRP. Blood culture was used as gold standard for diagnosis of NNS.Results: Of 50 neonates studied, 34 (68%) had positive CRP while 31 (62%) had positive blood culture. The sensitivity, specificity, positive and negative predictive values of CRP were 90.32%, 42.10%, 71.79% and 72.72% respectively.Conclusions: The qualitative method of estimating CRP which is cheap and rapid has moderate sensitivity, specificity and negative predictive value.

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

i-Perception ◽

10.1177/20416695211009928 ◽

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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The role of serum C-reactive protein in the diagnosis of periprosthetic shoulder infection

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03779-2 ◽

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.

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