C-reactive protein as predictor of bacterial infection among patients with an influenza-like illness

Haran, John P.; Beaudoin, Francesca L.; Suner, Selim; Lu, Shan

doi:10.1016/j.ajem.2012.06.026

Cited by 62 publications

(47 citation statements)

References 15 publications

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“…In the present study, the PPV of CRP&PCT (0.854) and the PPV of PCT (0.773) were much higher than the PPV of CRP (0.331), indicating that CRP&PCT or PCT alone might help clinicians to avoid unnecessary antibiotic therapy. Furthermore, our study showed that the diagnostic efficacy of PCT for bacterial co‐infection in H1N1 infection was better than that of CRP (AUC 0.801 and 0.783, respectively; P < 0.05), consistent with the results of a previous study . However, the AUC of WBC counts in diagnosing bacterial co‐infections was 0.551 (95% CI, 0.502‐0.592), indicating that WBC may not be a valuable biomarker for our cohort of children.…”

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

“…The diagnostic utility of CRP to differentiate bacterial co‐infection from H1N1 infection is disputed . Haran et al found that CRP served as a predictor of bacterial infection among patients with H1N1 infection. Similarly, Shin et al reported that serum CRP levels were significantly higher in patients with bacterial co‐infection compared with those infected with H1N1 alone.…”

Section: Discussionmentioning

confidence: 99%

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Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza

et al. 2018

Influenza Resp Viruses

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Objective This study evaluated the diagnostic value of measuring the levels of procalcitonin (PCT) and C‐reactive protein (CRP) to differentiate children co‐infected with H1N1 influenza and bacteria from children infected with H1N1 influenza alone. Methods Consecutive patients (children aged < 5 years) with laboratory‐confirmed H1N1 influenza who were hospitalized or received outpatient care from a tertiary‐care hospital in Canton, China, between January 1, 2012, and September 1, 2017, were included in the present study. Laboratory results, including serum PCT and CRP levels, white blood cell (WBC) counts, and bacterial cultures, were analyzed. The predictive value of the combination of biomarkers versus any of the biomarkers alone for diagnosing bacterial co‐infections was evaluated using logistic regression analyses. Results Significantly higher PCT (1.46 vs 0.21 ng/mL, P < 0.001) and CRP (19.20 vs 5.10 mg/dL, P < 0.001) levels were detected in the bacterial co‐infection group than in the H1N1 infection‐alone group. Using PCT or CRP levels alone, the areas under the curves (AUCs) for predicting bacterial co‐infections were 0.801 (95% CI, 0.772‐0.855) and 0.762 (95% CI, 0.722‐0.803), respectively. Using a combination of PCT and CRP, the logistic regression‐based model, Logit( P ) = −1.912 + 0.546 PCT + 0.087 CRP, showed significantly greater accuracy (AUC: 0.893, 95% CI: 0.842‐0.934) than did the other three biomarkers. Conclusions The combination of PCT and CRP levels could provide a useful method of distinguishing bacterial co‐infections from an H1N1 influenza infection alone in children during the early disease phase. After further validation, the flexible model derived here could assist clinicians in decision‐making processes.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza

et al. 2018

Influenza Resp Viruses

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“…One study reported CRP to be predictive for bacterial infection among adults with ILI [22]. Their receiver operating characteristic (ROC) analysis-derived cut-off for CRP was 20 mg/L, and their cases included bacterial pneumonia and other bacterial infections such as streptococcal pharyngitis and peritonsillar abscess.…”

Section: Discussionmentioning

confidence: 99%

Viral etiology in adult influenza-like illness/acute respiratory infection and predictivity of C-reactive protein

Cinemre

Karacer

Yücel

et al. 2016

J Infect Dev Ctries

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“…Another approach would be to integrate signs and symptoms with a point-of-care test such as c-reactive protein (CRP), as has been done for pneumonia and influenza diagnosis. 86,87 Greater use of urine antigen tests for L pneumophila should be encouraged for patients diagnosed with CAP, and the development of accurate, rapid point-of-care tests for C pneumoniae and B pertussis should be prioritized.…”

Section: Evidence For Underdiagnosismentioning

confidence: 99%

Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis

Marchello

Dale

Thai

et al. 2016

The Annals of Family Medicine

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PURPOSE Community-acquired pneumonia (CAP), acute cough, bronchitis, and lower respiratory tract infections (LRTI) are often caused by infections with viruses or Streptococcus pneumoniae. The prevalence of atypical pathogens Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, and Bordetella pertussis among patients with these illnesses in the ambulatory setting has not been previously summarized. We set out to derive prevalence information from the existing literature. METHODSWe performed a systematic review of MEDLINE for prospective, consecutive-series studies reporting the prevalence of M pneumoniae, C pneumoniae, L pneumophila and/or B pertussis in outpatients with cough, acute bronchitis, LRTI, or CAP. Articles were independently reviewed by 2 authors for inclusion and abstraction of data; discrepancies were resolved by consensus discussion. A meta-analysis was performed on each pathogen to calculate the pooled prevalence estimates using a random effects model of raw proportions.RESULTS Fifty studies met our inclusion criteria. While calculated heterogeneity was high, most studies reported prevalence for each pathogen within a fairly narrow range. In patients with CAP, the overall prevalences of M pneumoniae and C pneumoniae were 10.1% (95% CI, 7.1%-13.1%) and 3.5% (95% CI, 2.2%-4.9%), respectively. Consistent with previous reports, M pneumoniae prevalence peaked in roughly 6-year intervals. Overall prevalence of L pneumophila was 2.7% (95% CI, 2.0%-3.4%), but the organism was rare in children, with only 1 case in 1,765. In patients with prolonged cough in primary care, the prevalence of B pertussis was 12.4% (95% CI, 4.9%-19.8%), although it was higher in studies that included only children (17.6%; 95% CI, 3.4%-31.8%).CONCLUSIONS Atypical bacterial pathogens are relatively common causes of lower respiratory diseases, including cough, bronchitis, and CAP. Where surveillance data were available, we found higher prevalences in studies where all patients are tested for these pathogens. It is likely that these conditions are underreported, underdiagnosed, and undertreated in current clinical practice.

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C-reactive protein as predictor of bacterial infection among patients with an influenza-like illness

Cited by 62 publications

References 15 publications

Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza

Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza

Viral etiology in adult influenza-like illness/acute respiratory infection and predictivity of C-reactive protein

Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis

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