Usefulness of Early C-Reactive Protein Kinetics in Response and Prognostic Assessment in Infected Critically Ill Patients: An Observational Retrospective Study

Pereira, Marta; Rouxinol-Dias, Ana Lídia; Vieira, T.; Paiva, José Artur; Pereira, José Manuel

doi:10.20344/amp.12143

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Hospital-acquired infections frequently occur in patients with other noninfectious conditions, and at least half of patients admitted to an ICU are infected [ 7 , 8 ]. It can be challenging to obtain microbiological samples verifying an infection, which is particularly true for the critically ill patients often receiving broad-spectrum antibiotics [ 5 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Early Biomarker-Guided Prediction of Bloodstream Infection in Critically Ill Patients: C-Reactive Protein, Procalcitonin, and Leukocytes

Hertz

Ahlström

Bestle

et al. 2022

Open Forum Infectious Diseases

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Background Bloodstream infections (BSI) often lead to critical illness and death. The primary aim is to determine the diagnostic accuracy of the biomarkers C-reactive protein (CRP), procalcitonin (PCT) and leukocyte count for the diagnosis of BSI in critically ill patients. Material and Methods Nested case-control study based on the ‘Procalcitonin And Survival Study’(PASS) trial (n = 1200). Patients who were admitted to the ICU < 24 hours, and not expected to die <24 hours, were recruited. For the current study, we included patients with a BSI within +/- 3 days of ICU-admission, and matched controls without BSI in a 1:2 ratio. Diagnostic accuracy for BSI for the biomarkers on day 1, 2, and 3 of ICU admission was assessed. Sensitivity, specificity, negative and positive predictive values were calculated for pre-specified thresholds and for a data-driven cut off. Results In total 525 patients (n = 175 cases, 350 controls). The fixed low threshold for all 3 biomarkers (CRP = 20 mg/L, Leucocytes = 10 × 109/L, PCT = 0.4 ng/mL) resulted in negative predictive values on day 1: CRP: 0.91 (95% CI: 0.75 - 1.00), leukocyte: 0.75 (95% CI: 0.68 - 0.81), PCT: 0.91 (95% CI: 0.84 - 0.96). Combining the 3 biomarkers yielded similar results as PCT alone (p = 0.5). Conclusion CRP and PCT could in most cases rule out BSI in critically ill patients. Since almost no patients had low CRP and approximately 20% had low PCT, a low PCT could be used along with other information, to guide clinical decisions.

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Section: Discussionmentioning

confidence: 99%

Early Biomarker-Guided Prediction of Bloodstream Infection in Critically Ill Patients: C-Reactive Protein, Procalcitonin, and Leukocytes

Hertz

Ahlström

Bestle

et al. 2022

Open Forum Infectious Diseases

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“… 37,49,50 Only one of these trials examined CRP versus standard care 50 . Five additional studies evaluated the diagnostic or prognostic use of CRP in critically ill patients with infection 35,36,51–53 . Two meta‐analyses summarizing impact of CRP among critically ill patients were also identified, which contain additional studies of diagnostic and prognostic use of CRP beyond the scope of the present review 38,54 …”

Section: C‐reactive Protein Monitoring In Critically Ill Patients Wit...mentioning

confidence: 99%

Biomarkers in the intensive care setting: A focus on using procalcitonin and C‐reactive protein to optimize antimicrobial duration of therapy

et al. 2023

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Managing the critically ill patient with infection is complex, requiring clinicians to synthesize considerable information relating to antimicrobial efficacy and treatment duration. The use of biomarkers may play an important role in identifying variation in treatment response and providing information about treatment efficacy. Though a vast number of biomarkers for clinical application have been described, procalcitonin and C‐reactive protein (CRP) are the most thoroughly investigated in the critically ill. However, the presence of heterogeneous populations, variable end points, and incongruent methodology in the literature complicates the use of such biomarkers to guide antimicrobial therapy. This review focuses on an appraisal of evidence for use of procalcitonin and CRP to optimize antimicrobial duration of therapy (DOT) in critically ill patients. Procalcitonin‐guided antimicrobial therapy in mixed critically ill populations with varying degrees of sepsis appears to be safe and might assist in reducing antimicrobial DOT. Compared to procalcitonin, fewer studies exist examining the impact of CRP on antimicrobial DOT and clinical outcomes in the critically ill. Procalcitonin and CRP have been insufficiently studied in many key intensive care unit populations, including surgical patients with concomitant trauma, renally insufficient populations, the immunocompromised, and patients with septic shock. We believe the available evidence is not strong enough to warrant routine use of procalcitonin or CRP to guide antimicrobial DOT in critically ill patients with infection. So long as its limitations are recognized, procalcitonin could be considered to tailor antimicrobial DOT on a case‐by‐case basis in the critically ill patient.

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“…Yet, on a small-scale observational retrospective study by Pereira et al [ 28 ], 60 critically ill patients with community-acquired pneumonia, aspiration pneumonia, and bacteremia admitted to the intensive care unit had their CRP levels collected consecutively for up to eight days and were followed up to one year. No significant association was found between CRP kinetics and early or late mortality and antibiotic treatment duration ( p > 0.05).…”

Section: Using Crp Dynamics In the Diagnosis Of Infectious Diseasesmentioning

confidence: 99%

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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Usefulness of Early C-Reactive Protein Kinetics in Response and Prognostic Assessment in Infected Critically Ill Patients: An Observational Retrospective Study

Cited by 5 publications

References 30 publications

Early Biomarker-Guided Prediction of Bloodstream Infection in Critically Ill Patients: C-Reactive Protein, Procalcitonin, and Leukocytes

Early Biomarker-Guided Prediction of Bloodstream Infection in Critically Ill Patients: C-Reactive Protein, Procalcitonin, and Leukocytes

Biomarkers in the intensive care setting: A focus on using procalcitonin and C‐reactive protein to optimize antimicrobial duration of therapy

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

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