The potential benefit of a second C-reactive protein measurement in patients with gram-negative bacteraemia presenting to the emergency medicine department

Levinson, Tal; Tamir, Natalie; Shenhar‐Tsarfaty, Shani; Paran, Yael; Zeltzer, David; Shapira, Itzhak; Halpern, Pinchas; Meilik, Ahuva; Raykhshtat, Eli; Goldiner, Ilana; Adler, Amos; Berliner, Shlomo; Rogowski, Ori; Wasserman, Asaf

doi:10.1080/1354750x.2020.1797878

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…It should be noted that in the group of patients presenting with low CRP and a bacterial infection, there was a significant difference between the eCRPv and the CRPv. This was also demonstrated in a cohort [ 22 ] of patients presenting to the emergency room with Gram-negative bacteremia. Of 2200 patients with bacteremia, 460 had a low first CRP (<30 mg/L) of whom 229 were further investigated to find that they had a significant five-fold higher C-reactive protein level with their second test.…”

Section: Using Crp Dynamics In the Diagnosis Of Infectious Diseasesmentioning

confidence: 57%

C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation

Levinson

Wasserman

2022

IJMS

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C-reactive protein (CRP) is considered a biomarker of infection/inflammation. It is a commonly used tool for early detection of infection in the emergency room or as a point-of-care test and especially for differentiating between bacterial and viral infections, affecting decisions of admission and initiation of antibiotic treatments. As C-reactive protein is part of a dynamic and continuous inflammatory process, a single CRP measurement, especially at low concentrations, may erroneously lead to a wrong classification of an infection as viral over bacterial and delay appropriate antibiotic treatment. In the present review, we introduce the concept of C-reactive protein dynamics, measuring the velocity of C-reactive protein elevation, as a tool to increase this biomarker’s diagnostic ability. We review the studies that helped define new metrics such as estimated C-reactive protein velocity (velocity of C-reactive protein elevation from symptoms’ onset to first C-reactive protein measurement) and the measured C-reactive protein velocity (velocity between sequential C-reactive protein measurements) and the use of these metrics in different clinical scenarios. We also discuss future research directions for this novel metric.

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Section: Using Crp Dynamics In the Diagnosis Of Infectious Diseasesmentioning

confidence: 57%

C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation

Levinson

Wasserman

2022

IJMS

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“…In addition, we could show that a follow-up CRP test could add significant prognostic information to the medical team [ 4 , 5 , 6 , 7 , 8 ]. In fact, a second CRP test could single out those individuals who are at an increased risk of death during hospitalization [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Sepsis Related Mortality Associated with an Inflammatory Burst in Patients Admitting to the Department of Internal Medicine with Apparently Normal C-Reactive Protein Concentration

Meilik

Ben-Assayag

Meilik

et al. 2022

JCM

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Background: Patients who are admitted to the Department of Internal Medicine with apparently normal C-reactive protein (CRP) concentration impose a special challenge due the assumption that they might not harbor a severe and potentially lethal medical condition. Methods: A retrospective cohort of all patients who were admitted to the Department of Internal Medicine with a CRP concentration of ≤31.9 mg/L and had a second CRP test obtained within the next 24 h. Seven day mortality data were analyzed. Results: Overall, 3504 patients were analyzed with a mean first and second CRP of 8.8 (8.5) and 14.6 (21.6) mg/L, respectively. The seven day mortality increased from 1.8% in the first quartile of the first CRP to 7.5% in the fourth quartile of the first CRP (p < 0.0001) and from 0.6% in the first quartile of the second CRP to 9.5% in the fourth quartile of the second CRP test (p < 0.0001), suggesting a clear relation between the admission CRP and in hospital seven day mortality. Conclusions: An association exists between the quartiles of CRP and 7-day mortality as well as sepsis related cause of death. Furthermore, the CRP values 24 h after hospital admission improved the discrimination.

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“…Wassermann et al showed that 19.4% of patients admitted to ED with relatively low CRP levels (< 31.9 mg/L) and their discharge diagnosis was sepsis, died within 1 week of hospitalization [ 8 ]. Levinson et al presented that 6% of patients diagnosed with gram-negative bacteremia and had an initial low CRP measurement (< 30 mg/L) died within 1 week of hospitalization [ 9 ]. Feigin et al suggested that presentation to the internal medicine department with a very low concentration of CRP (< 0.05) does not exclude the existence of significant acute morbidities [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have shown the usefulness of sequential measurements of CRP as a tool in the follow-up of different conditions such as community-acquired Pneumonia, ventilator-associated pneumonia, bloodstream infection and sepsis [ 9 , 11 ]. The ratio between consecutive CRP measurements was suggested to assess the patient prognosis or the appropriateness of antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein velocity discriminates between acute viral and bacterial infections in patients who present with relatively low CRP concentrations

et al. 2021

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Background To assess the utility of C-reactive protein (CRP) velocity to discriminate between patients with acute viral and bacterial infections who presented with relatively low CRP concentrations and were suspected of having a bacterial infection. Methods We analyzed a retrospective cohort of patients with acute infections who presented to the emergency department (ED) with a relatively low first CRP measurement (CRP1) ≤ 31.9 mg/L and received antibiotics shortly after. We then calculated C-reactive protein velocity (CRPv), milligram per liter per hour, for each patient based on CRP1 and the second CRP value (CRP2) measured within the first 24 h since admission. Finally, we compared CRPv between patients with bacterial and viral infections. Results We have presently analyzed 74 patients with acute bacterial infections and 62 patients with acute viral infections at the mean age of 80 and 66 years respectively, 68 male and 68 female. CRP1 did not differ between both groups of patients (16.2 ± 8.6 and 14.8 ± 8.5 for patients with viral and bacterial infections respectively, p value = 0.336). However, the CRP2 was significantly different between the groups (30.2 ± 21.9 and 75.6 ± 51.3 for patients with viral and bacterial infections respectively, p-value < 0.001) and especially the CRPv was much higher in patients with acute bacterial infections compared to patients with acute viral infections (0.9 ± 1.2 and 4.4 ± 2.7 respectively, p-value < 0.001). Conclusion CRPv and CRP2 are useful biomarkers that can discriminate significantly between patients who present with acute bacterial and viral infections, and relatively low CRP concentration upon admission who were suspected of having a bacterial infection.

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The potential benefit of a second C-reactive protein measurement in patients with gram-negative bacteraemia presenting to the emergency medicine department

Cited by 11 publications

References 22 publications

C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation

C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation

Sepsis Related Mortality Associated with an Inflammatory Burst in Patients Admitting to the Department of Internal Medicine with Apparently Normal C-Reactive Protein Concentration

C-reactive protein velocity discriminates between acute viral and bacterial infections in patients who present with relatively low CRP concentrations

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