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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: Low C-reactive protein in acute bacterial infections could convey the erroneous impression of a mild infection. We focussed on gram-negative bacteraemia, a phenomenon frequently seen at the emergency room. Methods: Of 2200 patients with gram-negative bacteraemia, 460 patients with first C-reactive protein <30 mg/L and 460 patients with C-reactive protein >187 mg/L were reviewed. Following exclusions, we finally investigated 229 and 289 patients with low and high C-reactive protein concentrations, respectively. Results: The cohort was divided into low and high C-reactive protein groups. Median first C-reactive protein was 13.6 and 219.9 mg/L, respectively (interquartile range 6.4–21.6 and 195–270.1). Compared to patients with first high C-reactive protein, patients with first low C-reactive protein concentrations had a significant five-fold higher C-reactive protein level with their second test. Conclusions: Patients with gram-negative bacteraemia can present with C-reactive protein within the range of apparently healthy individuals. A second C-reactive protein might help to avoid an erroneous decision regarding the severity of the infection.

Original languageEnglish
Pages (from-to)533-538
Number of pages6
JournalBiomarkers
Volume25
Issue number7
DOIs
StatePublished - 2 Oct 2020

Keywords

  • C-reactive protein
  • cytokines
  • department of emergency medicine
  • gram-negative bacteraemia
  • inflammation

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