Using the kinetics of C-reactive protein response to improve the differential diagnosis between acute bacterial and viral infections

Dan Coster, Asaf Wasserman, Eyal Fisher, Ori Rogowski, David Zeltser, Itzhak Shapira, Daniel Bernstein, Ahuva Meilik, Eli Raykhshtat, Pinchas Halpern, Shlomo Berliner, Shani Shenhar-Tsarfaty*, Ron Shamir

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Differential diagnosis between acute viral and bacterial infection is an emerging common challenge for a physician in the emergency department. Serum C-reactive protein (CRP) is used to support diagnosis of bacterial infection, but in patients admitted with low CRP, its ability to discriminate between viral and bacterial infections is limited. We aimed to use two consecutive CRP measurements in order to improve differential diagnosis between bacterial and viral infection. Methods: A single-center retrospective cohort (n = 1629) study of adult patients admitted to the emergency department with a subsequent microbiological confirmation of either viral or bacterial infection. Trend of CRP was defined as the absolute difference between the first two measurements of CRP divided by the time between them, and we investigated the ability of this parameter to differentiate between viral and bacterial infection. Results: In patients with relatively low initial CRP concentration (< 60 mg/L, n = 634 patients), where the uncertainty regarding the type of infection is the highest, the trend improved diagnosis accuracy (AUC 0.83 compared to 0.57 for the first CRP measurement). Trend values above 3.47 mg/L/h discriminated bacterial from viral infection with 93.8% specificity and 50% sensitivity. Conclusions: The proposed approach for using the kinetics of CRP in patients whose first CRP measurement is low can assist in differential diagnosis between acute bacterial and viral infection.

Original languageEnglish
Pages (from-to)241-248
Number of pages8
Issue number2
StatePublished - 1 Apr 2020


FundersFunder number
Edmond J. Safra Center for Bioinformatics
Naomi Prawer Kadar Foundation
National Science Foundation
United States-Israel Binational Science Foundation
Israel Science Foundation2016694, 1339/18
Tel Aviv University


    • Bacterial
    • C-reactive protein
    • Differential diagnosis
    • Infection
    • Viral


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