The added value of C-reactive protein measurement in diagnosing pneumonia in primary care: a meta-analysis of individual patient data

Minnaard, Margaretha C.; Groot, Joris A H de; Hopstaken, Rogier; Schierenberg, Alwin; Wit, Niek J. de; Reitsma, Johannes B.; Broekhuizen, Berna D L; Vugt, Saskia F. de Vries-van; Neven, Arie Knuistingh; Graffelman, Aleida W.; Melbye, Hasse; Rainer, Timothy; Steurer, Johann; Holm, Anette; Gonzales, Ralph; Dinant, Geert‐Jan; Pol, Alma C van de; Verheij, Theo

doi:10.1503/cmaj.151163

Cited by 48 publications

(46 citation statements)

References 25 publications

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“…However, like many other clinical decision rules, it still left a group of patients classified at intermediate risk, in which clinical decision-making remains challenging. 9 This is very much in line with qualitative evidence showing that GPs sometimes struggle with intermediate results. 10 The current NICE guideline for pneumonia now advises physicians to consider a delayed prescription for patients with intermediate CRP values between 20 mg/L and 100 mg/L.…”

Section: The Impact Of Crp On Antibiotic Prescribing Decisionssupporting

confidence: 70%

C-reactive protein: guiding antibiotic prescribing decisions at the point of care

Cals

Ebell

2018

Br J Gen Pract

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Section: The Impact Of Crp On Antibiotic Prescribing Decisionssupporting

confidence: 70%

C-reactive protein: guiding antibiotic prescribing decisions at the point of care

Cals

Ebell

2018

Br J Gen Pract

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“…It was identi ed as a predictor of pneumonia in several studies. [11,[20][21][22] A CRP level ≤ 10 mg/L was useful for ruling out CAP in most patients. [11]Steurer et al found there was no pneumonia diagnosed when the CRP levels were < 10 mg/L or if the CRP levels were between 11 and 50 mg/L and the patient did not complain of dyspnea and fever associated with cough.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and predictors of pneumonia in patients presenting fever or respiratory symptoms with normal or low leukocyte counts: a retrospective study

Wang¹,

Liu²,

Li³

et al. 2020

Preprint

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Background Many patients went to the hospital presenting with acute fever, or respiratory symptoms, most of whom have a normal or low leukocyte counts. The aim of this study was to investigate the clinical characteristics and predictors of pneumonia in those patients. Methods In this retrospective study, adult patients (≥ 18 years old) presenting with acute fever or respiratory symptoms with normal or low leukocyte counts (≤ 9.5 × 109/L) in Peking Union Medical College Hospital between 26 January 2020 and 10 March 2020 were included. Patients were categorized into groups with pneumonia or upper respiratory tract infection (URTI) according to chest CT scans. Logistic regression was used to explore predictors of pneumonia. Results A total of 195 patients were included, 63 of whom were diagnosed with pneumonia. The median maximum body temperature was 38.5 °C (38.0-38.8 °C) in patients with pneumonia and 37.5 °C (37.4–37.8 °C) in the other group. There was a significant difference in high-sensitivity C-reactive protein (hsCRP) levels between the two groups (0.21 (0-3.74) versus 33.4 (15.5–75.5) mg/L, p < 0.001). Multivariable regression showed that the predictive values of pneumonia were older age (OR 1.06, 95% CI 1.02–1.10, p = 0.004), cough (OR 0.18, 95%CI 0.06–0.56; p = 0.003), higher temperature (OR 3.36, 95%CI 1.16–9.71; p = 0.025) and higher hsCRP level (OR 1.05, 95%CI 1.02–1.09; p = 0.003). The optimal cutoff values based on the ROC curve analysis were a temperature of 37.8 °C and a hsCRP level of 1.64 mg/L. Conclusions Patients with older age, cough, higher temperature and higher hsCRP level were more inclined to have pneumonia. Temperatures higher than 37.8 °C were a potential predictor of pneumonia in patients with normal or low leukocyte counts in the early stage. However, a hsCRP level less than 1.64 mg/L could rule out most cases of pneumonia.

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“…Mortalidad a 30 días 0,53 0,43 -0,62 0,780 tabla 5. Evolución de la proteína C reactiva sérica a las 72 h de la admisión al hospital en la pesquisa de eventos adversos en pacientes adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad falla en la declinación de la pCr sérica a las 72 h* los servicios de atención primaria, especialmente en aquellos que no tienen acceso a exámenes radiológicos [21][22][23][24][25] . En una revisión sistemática, el área bajo la curva receptor operador de la PCR sérica para confirmar el diagnóstico clínico de neumonía fue 0,80 (IC 95%: 0,75-0,85); con diferentes puntos de corte del examen, la sensibilidad (10-98%) y especificidad (44-99%) fueron muy variables 22 .…”

Section: Discussionunclassified

“…En una revisión sistemática, el área bajo la curva receptor operador de la PCR sérica para confirmar el diagnóstico clínico de neumonía fue 0,80 (IC 95%: 0,75-0,85); con diferentes puntos de corte del examen, la sensibilidad (10-98%) y especificidad (44-99%) fueron muy variables 22 . La PCR sérica medida en los pacientes adultos atendidos por síntomas respiratorios agudos permitiría confirmar el diagnóstico clínico de neumonía y reduciría la prescripción inapropiada de antimicrobianos en los servicios de atención primaria 25 . En nuestro estudio, la PCR sérica elevada en la admisión al hospital permitió predecir el riesgo de neumonía bacteriémica.…”

Section: Discussionunclassified

Utilidad de la proteína C reactiva sérica en el diagnóstico y tratamiento del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

Saldías-Peñafiel

Salinas-Rossel²,

Farcas-Oksenberg³

et al. 2019

Rev. méd. Chile

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Utilidad de la proteína C reactiva sérica en el diagnóstico y tratamiento del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidadFernando saldías PeñaFiel 1 , gerardo salinas rossel a , katia Farcas oksenBerg b , antonia reyes sánchez b , orlando díaz Patiño 1Immunocompetent adults hospitalized for a community-acquired pneumonia: Serum C-reactive protein as a prognostic marker Background: C-reactive protein (CRP) is used to monitor patients' response during treatment of infectious diseases. Morbidity and mortality associated with community-acquired pneumonia (CAP) is high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality rates. Aim: To evaluate CRP measured at admission and the third day of hospitalization as a predictor for adverse events in CAP. Material and Methods: A prospective cohort study of adult patients hospitalized with CAP at an academic hospital. Major adverse outcomes were admission to ICU, mechanical ventilation, prolonged hospital length of stay, hospital complications and 30-day mortality. Predictive associations between CRP (as absolute levels and relative decline at third day) and adverse events were analyzed. Results: Eight hundred and twenty-three patients were assessed, 19% were admitted to ICU and 10.6% required mechanical ventilation. The average hospital stay was 8.8 ± 8.2 days, 42% had nosocomial complications and 8.1% died within 30 days. Ninety eight percent of patients had elevated serum CRP on admission to the hospital (18.1 ± 14.1 mg/dL). C-reactive protein measured at admission was associated with the risk of bacterial pneumonia, bacteremic pneumonia, septic shock and use of mechanical ventilation. Lack of CRP decline within three days of hospitalization was associated with high risk of complications, septic shock, mechanical ventilation and prolonged hospital stay. Conclusions: CRP responses at third day of hospital admission was a valuable predictor of adverse events in hospitalized CAP adult patients. (Rev Med Chile 2019; 147: 983-992)

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The added value of C-reactive protein measurement in diagnosing pneumonia in primary care: a meta-analysis of individual patient data

Cited by 48 publications

References 25 publications

C-reactive protein: guiding antibiotic prescribing decisions at the point of care

C-reactive protein: guiding antibiotic prescribing decisions at the point of care

Clinical characteristics and predictors of pneumonia in patients presenting fever or respiratory symptoms with normal or low leukocyte counts: a retrospective study

Utilidad de la proteína C reactiva sérica en el diagnóstico y tratamiento del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

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