scholarly journals Peer Review #1 of "Diagnostic value of serum procalcitonin, lactate, and high-sensitivity C-reactive protein for predicting bacteremia in adult patients in the emergency department (v0.1)"

2017 ◽  
Keyword(s):  
Emergency Department ◽  
Peer Review ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Adult Patients ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals Diagnostic value of serum procalcitonin, lactate, and high-sensitivity C-reactive protein for predicting bacteremia in adult patients in the emergency department

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e4094 ◽  
Author(s):  
Chiung-Tsung Lin ◽  
Jang-Jih Lu ◽  
Yu-Ching Chen ◽  
Victor C. Kok ◽  
Jorng-Tzong Horng
Keyword(s):  
Emergency Department ◽  
Odds Ratio ◽  
High Sensitivity ◽  
Diagnostic Odds Ratio ◽  
Adult Patients ◽  
C Reactive Protein ◽  
Optimal Cutoff ◽  
Discriminative Ability ◽  
Gram Negative ◽  
Reactive Protein

Background Few studies compared the diagnostic value of procalcitonin with a combination of other tests including lactate and high-sensitivity C-reactive protein in the prediction of pathogenic bacteremia in emergency department adult patients. Methods We performed a retrospective study assessing the differences in performances of procalcitonin at a cutoff of 0.5 ng/mL, lactate at a cutoff of 19.8 mg/dL, high-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL and their combinations for predicting bacteremia in emergency department adult patients. Sensitivity, specificity, overall accuracy, positive-test and negative-test likelihood, and diagnostic odds ratio with 95% confidence interval for each test combination were calculated for comparison. The receiver operating characteristic curve for every single test were compared using DeLong’s method. We also performed a sensitivity analysis in two expanded patient cohorts to assess the discriminative ability of procalcitonin or test combination. Results A total of 886 patients formed the initial patient cohort. The area under the receiver operating characteristic curve for discriminating positive blood culture was: procalcitonin = 0.72 (95% CI [0.69–0.75]) with a derived optimal cutoff at 3.9 ng/mL; lactate 0.69 (0.66–0.72) with an optimal cutoff at 17.9 mg/dL; high-sensitivity C-reactive protein 0.56 (0.53–0.59) with an optimal cutoff of 13 mg/dL; with pairwise comparisons showing statistically significant better performance of either procalcitonin or lactate outperforming high-sensitivity C-reactive protein. To predict positive blood cultures, the diagnostic odds ratio for procalcitonin was 3.64 (95% CI [2.46–5.51]), lactate 2.93 (2.09–4.14), and high-sensitivity C-reactive protein 0.91 (0.55–1.55; P = 0.79). About combined tests, the diagnostic odds ratio for procalcitonin and lactate increases were 3.98 (95% CI [2.81–5.63]) for positive blood culture prediction. Elevated procalcitonin level rendered a six-fold increased risk of positive gram-negative bacteremia with a diagnostic odds ratio of 6.44 (95% CI [3.65–12.15]), which showed no further improvement in any test combinations. In the sensitivity analysis, as a single test to predict unspecified, gram-negative and gram-positive bacteremia, procalcitonin performed even better in an expanded cohort of 2,234 adult patients in terms of the diagnostic odds ratio. Discussions For adult emergency patients, procalcitonin has an acceptable discriminative ability for bacterial blood culture and a better discriminative ability for gram-negative bacteremia when compared with lactate and high-sensitivity C-reactive protein. High-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL performed poorly for the prediction of positive bacterial culture.

scholarly journals High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e015112 ◽  
Author(s):  
Ryo Yoshinaga ◽  
Yasufumi Doi ◽  
Katsuhiko Ayukawa ◽  
Shizukiyo Ishikawa
Keyword(s):  
Cardiovascular Disease ◽  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
High Sensitivity ◽  
Inhospital Mortality ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp

ObjectiveWe investigated whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are associated with inhospital mortality in patients with cardiovascular disease (CVD).DesignA retrospective cohort study.SettingED of a teaching hospital in Japan.Participants12 211 patients with CVD aged ≥18 years who presented to the ED by an ambulance between 1 February 2006 and 30 September 2014 were evaluated.Main outcome measuresInhospital mortality.Results1156 patients had died. The inhospital mortality increased significantly with the hs-CRP levels (<3.0 mg/L: 7.0%, 95% CI 6.4 to 7.6; 3.1–5.4 mg/L: 9.6%, 95% CI 7.9 to 11.3: 5.5–11.5 mg/L: 11.2%, 95% CI 9.4 to 13.0; 11.6–33.2 mg/L: 12.3%, 95% CI 10.5 to 14.1 and ≥33.3 mg/L: 19.9%, 95% CI 17.6 to 22.2). The age-adjusted and sex-adjusted HR for total mortality was increased significantly in the three ≥5.5 mg/L groups compared with the <3.0 mg/L group (5.5–11.5 mg/L: HR=1.32, 95% CI 1.09 to 1.60, p=0.005; 11.6–33.2 mg/L: HR=1.38, 95% CI 1.14 to 1.65, p=0.001 and ≥33.3 mg/L: HR=2.15, 95% CI 1.84 to 2.51, p<0.001). Similar findings were observed for the CVD subtypes of acute myocardial infarction, heart failure, cerebral infarction and intracerebral haemorrhage. This association remained unchanged even after adjustment for age, sex and white cell count and withstood Bonferroni adjustment for multiple testing. When the causes of death were divided into primary CVD and non-CVD deaths, the association between initial hs-CRP levels and mortality remained significant, but the influence of hs-CRP levels was greater in non-CVD deaths than CVD deaths. The percentage of non-CVD deaths increased with hs-CRP levels; among the patients with hs-CRP levels ≥33.3 mg/L, non-CVD deaths accounted for 37.5% of total deaths.ConclusionOur findings suggest that increased hs-CRP is a significant risk factor for inhospital mortality among patients with CVD in an ED. Particular attention should be given to our finding that non-CVD death is a major cause of death among patients with CVD with higher hs-CRP levels.

scholarly journals The relationship and diagnostic value of C-reactive protein (CRP) and high-sensitivity- reactive protein (hsCRP) for myocardial infarction

2011 ◽  
Vol 5 (20) ◽  
pp. 3215-3219
Author(s):  
Honarm H ◽  
Mirzajani E ◽  
Rahbar Taromsari M ◽  
Saadat F ◽  
Mirblock F ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Relationship

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.

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