Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP – Results from the German competence network CAPNETZ

Krüger, Stefan; Ewig, Santiago; Papassotiriou, Jana; Kunde, Jan; Marre, R.; Baum, Heike von; Suttor, Norbert; Welte, Tobias

doi:10.1186/1465-9921-10-65

Cited by 109 publications

(103 citation statements)

References 38 publications

(42 reference statements)

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“…Levels of CRP may also be elevated in patients with viral infections, although generally not to the degree seen in patients with bacterial infections. 10,11 Simon and others 11 evaluated the accuracy of determination of CRP levels for differentiating bacterial infections from viral fever and reported a sensitivity and specificity of 86% (95% CI = 65-95%) and 70% (95% CI = 19-96%), respectively. CRP levels are also elevated in malaria patients and useful in assessing malaria severity and followup.…”

Section: Discussionmentioning

confidence: 99%

The Usefulness of Serum C-Reactive Protein and Total Bilirubin Levels for Distinguishing Between Dengue Fever and Malaria in Returned Travelers

Kutsuna

Hayakawa

Kato

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. The clinical manifestations of dengue fever (DF) and malaria are similar. Specific diagnostic tests are not always available. A retrospective study to compare the laboratory results of malaria and DF was conducted at the National Center for Global Health and Medicine in Japan from January of 2005 to March of 2013. Febrile returned travelers from overseas diagnosed with malaria or DF were included; 86 malaria and 85 DF cases were identified. C-reactive protein (CRP) and total bilirubin (T-bil) had high area under the receiver operating characteristic curves ( 0.9). A cutoff value of CRP 2.4 mg/dL to predict malaria as opposed to DF had a sensitivity of 91.9% (95% confidence interval [95% CI] = 83.9-96.7%) and specificity of 90.6% (95% CI = 82.3-95.8%). A cutoff value of T-bil 0.9 mg/dL to predict malaria as opposed to DF had a sensitivity of 73.8% (95% CI = 62.7-83%) and a specificity of 95.1% (95% CI = 88-98.6%). CRP and T-bil are useful to distinguish between DF and malaria in returned travelers.

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Section: Discussionmentioning

confidence: 99%

The Usefulness of Serum C-Reactive Protein and Total Bilirubin Levels for Distinguishing Between Dengue Fever and Malaria in Returned Travelers

Kutsuna

Hayakawa

Kato

et al. 2014

The American Society of Tropical Medicine and Hygiene

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“…One possible explanation is a delayed PCT rise after septic stimulus, which can cause a diagnostic gap requiring repeated measurements. Although PCT is more specific than CRP for bacterial infections, its accuracy still does not allow individual prediction of aetiology [72]. Another problem of both markers is their poor prediction of high risk patients.…”

Section: Inflammatory Biomarkersmentioning

confidence: 99%

Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

2012

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Community-acquired pneumonia (CAP) represents a major life-threatening infection, but disease course and outcome is highly variable. Major drivers of prognosis are respiratory failure, sepsis-related organ dysfunction and unstable comorbidities.Current risk stratification tools have been primarily designed to predict mortality and identify low risk patients potentially suitable for ambulatory management. Detection of patients at high risk for clinical deterioration by current scores remains suboptimal.Therefore, management-related risk stratification tools designed to predict benefit from early intensified monitoring and treatment strategies in hospitalised CAP are advocated. An approach including early and repeatedly evaluated clinical markers of respiratory failure, sepsis-related organ dysfunction or decompensating comorbidity combined with individual definition of treatment goals is suggested.Inflammatory biomarkers can add prognostic information. New cardiovascular or stress-related biomarkers like copeptin, midregional proadrenomedullin and cortisol have been repeatedly linked with outcome and disease course in CAP and improved clinical scoring in observational studies. Thus they represent promising tools for individualised risk stratification. A major task in future CAP research will be the evaluation of their additional value in large interventional trials with control groups incorporating strict management guidance by clinical criteria.

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“…Increased levels of PCT (and of CRP) have been found in Streptococcus pneumoniae CAP when compared with atypical bacterial or viral pneumonias [7,16], but a possible aetiological discrimination capacity of MR-proADM is not yet known.…”

mentioning

confidence: 99%

“…C-reactive protein (CRP) and procalcitonin (PCT) have shown their usefulness for diagnosis [6], suspicion of typical bacteria as the causal agent [7], guiding antibiotic therapy [8], and assessing severity, mortality risk and the potential for complications [9,10]. Other new biomarkers have been proposed to provide information on severity and prognosis, including midregional (MR) proadrenomedullin (proADM).…”

mentioning

confidence: 99%

Prognostic power of proadrenomedullin in community-acquired pneumonia is independent of aetiology

Bello¹,

Lasierra²,

Mincholé³

et al. 2011

Eur Respir J

110

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Biomarkers are useful in community-acquired pneumonia (CAP). Recently, midregional (MR) proadrenomedullin (proADM) has been shown to be of potential prognostic use. We sought to determine whether this prognostic role depends on the cause of CAP.We conducted a prospective cohort study of immunocompetent patients with CAP. Pneumonia Severity Index (PSI) and CURB-65 score (confusion (abbreviated mental test score of f8), urea o7 mol?L -1 , respiratory rate o30 breaths?min -1 , blood pressure ,90 mmHg systolic or ,60 mmHg diastolic, and age o65 yrs), blood C-reactive protein, procalcitonin, MR-proADM, and microbiological studies were systematically performed. Patients were grouped as bacterial, viral/atypical and mixed CAP, and were followed up at 30, 90 and 180 days, and 1 yr. We recruited 228 CAP patients. Identification of at least one pathogen was achieved in 155 (68%) patients. MR-proADM levels closely correlated with increasing severity scores, and showed an important predictive power for complications and short-and long-term mortality (1 yr). Its addition to PSI and CURB-65 significantly improved their prognostic accuracy. A MR-proADM cutoff of 0.646 nmol?L -1 identified 92% of patients scored as PSI classes IV and V as high risk. MRproADM outcome prediction power was not affected by different aetiologies. MR-proADM has high short-and long-term prognostic accuracy, and increases the accuracy of clinical scores. The prognostic value of MR-proADM is not modified by different possible CAP aetiologies.

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Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP – Results from the German competence network CAPNETZ

Abstract: Background: Aim of this study was to evaluate the correlation of inflammatory markers procalcitonin (PCT), C-reactive protein (CRP) and leukocyte count (WBC) with microbiological etiology of CAP.

Cited by 109 publications

References 38 publications

The Usefulness of Serum C-Reactive Protein and Total Bilirubin Levels for Distinguishing Between Dengue Fever and Malaria in Returned Travelers

The Usefulness of Serum C-Reactive Protein and Total Bilirubin Levels for Distinguishing Between Dengue Fever and Malaria in Returned Travelers

Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

Prognostic power of proadrenomedullin in community-acquired pneumonia is independent of aetiology

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