C-reactive protein as an indicator of bacterial infection of adult patients in the emergency department.

Yi Ling Chan, Hao Chin Liao, Pei Kuei Tsay, Shy Shin Chang, Jih Chang Chen, Shiumn Jen Liaw

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: This investigation evaluates the feasibility of using C-reactive protein (CRP) levels as an indicator of bacterial infection of adult patients in the Emergency Department (ED), by comparing them with clinical signs and routine laboratory tests. METHODS: One hundred and fifty adult atraumatic patients admitted through the ED of Linkou Chang Gung Memorial Hospital were consecutively enrolled. Seventy-nine patients had documented infection, and 58 had no infection. Body temperature (BT), white blood cell (WBC) count, CRP levels, and the presence of systemic inflammatory response syndrome (SIRS) were compared between the infected and uninfected groups. RESULTS: SIRS was the most sensitive indicator of bacterial infection (sensitivity 84.8%), but it had a 37.9% false-positive rate. BT and WBC count were more specific (at 89.7% and 84.5%) but less sensitive (at 48.1% and 43.0%, respectively). Using Youden's Index, the best cut-off value for CRP was 60 mg/l (sensitivity 67.1%, specificity 94.8%, positive predictive value 94.6%, and negative predictive value 67.9%). The area under the receiver operating characteristics (ROC) curve was highest for CRP (at 0.88), followed by BT (at 0.77) and WBC (at 0.67) (all p < 0.05). CONCLUSION: CRP is a better indicator of bacterial infection than either BT or WBC count for adult atraumatic ED patients. A low serum CRP level cannot safely be used to exclude the presence of infection.

Original languageEnglish
Pages (from-to)437-445
Number of pages9
JournalChang Gung Medical Journal
Volume25
Issue number7
Publication statusPublished - Jul 1 2002
Externally publishedYes

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Bacterial Infections
C-Reactive Protein
Hospital Emergency Service
Body Temperature
Leukocyte Count
Systemic Inflammatory Response Syndrome
Infection
ROC Curve
Blood Proteins
Leukocytes
Sensitivity and Specificity

ASJC Scopus subject areas

  • Medicine(all)

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C-reactive protein as an indicator of bacterial infection of adult patients in the emergency department. / Chan, Yi Ling; Liao, Hao Chin; Tsay, Pei Kuei; Chang, Shy Shin; Chen, Jih Chang; Liaw, Shiumn Jen.

In: Chang Gung Medical Journal, Vol. 25, No. 7, 01.07.2002, p. 437-445.

Research output: Contribution to journalArticle

Chan, Yi Ling ; Liao, Hao Chin ; Tsay, Pei Kuei ; Chang, Shy Shin ; Chen, Jih Chang ; Liaw, Shiumn Jen. / C-reactive protein as an indicator of bacterial infection of adult patients in the emergency department. In: Chang Gung Medical Journal. 2002 ; Vol. 25, No. 7. pp. 437-445.
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abstract = "BACKGROUND: This investigation evaluates the feasibility of using C-reactive protein (CRP) levels as an indicator of bacterial infection of adult patients in the Emergency Department (ED), by comparing them with clinical signs and routine laboratory tests. METHODS: One hundred and fifty adult atraumatic patients admitted through the ED of Linkou Chang Gung Memorial Hospital were consecutively enrolled. Seventy-nine patients had documented infection, and 58 had no infection. Body temperature (BT), white blood cell (WBC) count, CRP levels, and the presence of systemic inflammatory response syndrome (SIRS) were compared between the infected and uninfected groups. RESULTS: SIRS was the most sensitive indicator of bacterial infection (sensitivity 84.8{\%}), but it had a 37.9{\%} false-positive rate. BT and WBC count were more specific (at 89.7{\%} and 84.5{\%}) but less sensitive (at 48.1{\%} and 43.0{\%}, respectively). Using Youden's Index, the best cut-off value for CRP was 60 mg/l (sensitivity 67.1{\%}, specificity 94.8{\%}, positive predictive value 94.6{\%}, and negative predictive value 67.9{\%}). The area under the receiver operating characteristics (ROC) curve was highest for CRP (at 0.88), followed by BT (at 0.77) and WBC (at 0.67) (all p < 0.05). CONCLUSION: CRP is a better indicator of bacterial infection than either BT or WBC count for adult atraumatic ED patients. A low serum CRP level cannot safely be used to exclude the presence of infection.",
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N2 - BACKGROUND: This investigation evaluates the feasibility of using C-reactive protein (CRP) levels as an indicator of bacterial infection of adult patients in the Emergency Department (ED), by comparing them with clinical signs and routine laboratory tests. METHODS: One hundred and fifty adult atraumatic patients admitted through the ED of Linkou Chang Gung Memorial Hospital were consecutively enrolled. Seventy-nine patients had documented infection, and 58 had no infection. Body temperature (BT), white blood cell (WBC) count, CRP levels, and the presence of systemic inflammatory response syndrome (SIRS) were compared between the infected and uninfected groups. RESULTS: SIRS was the most sensitive indicator of bacterial infection (sensitivity 84.8%), but it had a 37.9% false-positive rate. BT and WBC count were more specific (at 89.7% and 84.5%) but less sensitive (at 48.1% and 43.0%, respectively). Using Youden's Index, the best cut-off value for CRP was 60 mg/l (sensitivity 67.1%, specificity 94.8%, positive predictive value 94.6%, and negative predictive value 67.9%). The area under the receiver operating characteristics (ROC) curve was highest for CRP (at 0.88), followed by BT (at 0.77) and WBC (at 0.67) (all p < 0.05). CONCLUSION: CRP is a better indicator of bacterial infection than either BT or WBC count for adult atraumatic ED patients. A low serum CRP level cannot safely be used to exclude the presence of infection.

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