Serum C-reactive protein as a biomarker for early detection of bacterial infection in the older patient.

BACKGROUND although C-reactive protein (CRP) is widely used in younger populations, its value for diagnosing bacterial infection in older population is not well established. This study examined the usefulness of serum CRP level in the early detection of bacterial infection in older patients. METHODS in a prospective cohort study, consecutive patients aged 70 years or over admitted to Aged Care wards were recruited. CRP levels were measured within 24 h of presentation, and their significance in predicting bacterial infections was analysed. The relationship between CRP and other clinical features of diagnosing bacterial infections (e.g. temperature, white cell count, neutrophil count, oxygen saturation, blood pressure and heart rate) was also examined. RESULTS a total of 232 patients were recruited over a period of 3 months. CRP levels were 21.3 +/- 36.0 and 150.5 +/- 114.1 mg/l (mean +/- SD) in the non-infection and infection groups, respectively (P < 0.001). We found that the CRP cut-off value of 60 mg/l had the best combination of sensitivity and specificity. At this level, the sensitivity of diagnosing bacterial infection was 80.7%, specificity 96.0%, positive predictive value 91.9% and negative predictive value 89.8%. CRP and temperature had higher sensitivity and specificity than white cell count and neutrophil count in the diagnosis of infection. For every 1-mg/l increment in CRP, the risk of bacterial infection increases by 2.9%. CONCLUSION CRP is a convenient and useful biomarker to predict early bacterial infection in older patients especially when other markers are atypical or not present.

[1]  J. Rello,et al.  C-reactive protein correlates with bacterial load and appropriate antibiotic therapy in suspected ventilator-associated pneumonia , 2008, Critical care medicine.

[2]  R. Kenny,et al.  Acute phase protein response to infection in elderly patients. , 1984, Age and ageing.

[3]  J. Addington-hall,et al.  Palliative care in stroke: a critical review of the literature , 2007, Palliative medicine.

[4]  I. Maidment,et al.  Age and Ageing , 2018 .

[5]  D. Newman.  Urinary incontinence, catheters, and urinary tract infections: an overview of CMS tag F 315. , 2006, Ostomy/wound management.

[6]  J. Addington-hall,et al.  Regional Study of Care for the Dying: methods and sample characteristics , 1995, Palliative medicine.

[7]  Tokuo Yoshida,et al.  Palliative Care: the World Health Organization's global perspective. , 2002, Journal of pain and symptom management.

[8]  S. Payne,et al.  Dying trajectories in heart failure , 2007, Palliative medicine.

[9]  P. Heinrich,et al.  Acute‐phase response of human hepatocytes: Regulation of acute‐phase protein synthesis by interleukin‐6 , 1990, Hepatology.

[10]  C. McPherson,et al.  Judging the quality of care at the end of life: can proxies provide reliable information? , 2003, Social science & medicine.

[11]  P. Couturier,et al.  Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: The SAFES cohort study , 2008, The journal of nutrition, health & aging.

[12]  B. Celli,et al.  C-reactive protein levels and survival in patients with moderate to very severe COPD. , 2008, Chest.

[13]  D. Bates,et al.  The association of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infection. , 2006, Annals of emergency medicine.

[14]  R. Dunlop.  Specialist palliative care and non-malignant diseases , 2001 .

[15]  A. Barnett,et al.  Systematic review of the diagnostic accuracy of C-reactive protein to detect bacterial infection in nonhospitalized infants and children with fever. , 2008, The Journal of pediatrics.

[16]  J. Starr,et al.  Acute phase proteins, C-reactive protein and serum amyloid A protein, as prognostic markers in the elderly inpatient. , 1997, Age and ageing.

[17]  M. Dempster,et al.  The challenge of patients' unmet palliative care needs in the final stages of chronic illness , 2007, Palliative medicine.

[18]  S. Albert,et al.  Epidemiologie und Therapie bakterieller Infektionen in der Geriatrie , 2000, Zeitschrift für Gerontologie und Geriatrie.

[19]  I. Higginson,et al.  Where people die (1974—2030): past trends, future projections and implications for care , 2008, Palliative medicine.

[20]  P. Aavitsland,et al.  Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway, 2002 and 2003. , 2004, The Journal of hospital infection.

[21]  S. Hunziker,et al.  The value of serum procalcitonin level for differentiation of infectious from noninfectious causes of fever after orthopaedic surgery. , 2010, The Journal of bone and joint surgery. American volume.

[22]  L. Armstrong.  A Prospective Multicenter Derivation of a Biomarker Panel to Assess Risk of Organ Dysfunction, Shock, and Death in Emergency Department Patients with Suspected Sepsis , 2009 .

[23]  P. Póvoa,et al.  C-reactive protein as an indicator of sepsis , 1998, Intensive Care Medicine.

[24]  B. Pedersen,et al.  Elderly humans show prolonged in vivo inflammatory activity during pneumococcal infections. , 1999, The Journal of infectious diseases.

[25]  D. Christiani,et al.  Plasma C-reactive protein levels are associated with improved outcome in ARDS. , 2009, Chest.

[26]  A. Moreno,et al.  Cytokine-Release Patterns in Elderly Patients with Systemic Inflammatory Response Syndrome , 2007, Gerontology.

[27]  C. McPherson,et al.  Feeling like a burden to others: a systematic review focusing on the end of life , 2007, Palliative medicine.

[28]  L. Storey,et al.  The Preferred Place of Care document: an opportunity for communication. , 2003, International journal of palliative nursing.

[29]  L. Rodríguez-Mañas,et al.  Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis , 2009, BMJ : British Medical Journal.

[30]  T. D. Du Clos,et al.  Function of C-reactive protein. , 2000 .

[31]  B. Jack,et al.  Towards a good death: the impact of the care of the dying pathway in an acute stroke unit. , 2004, Age and ageing.

[32]  P. Knapp,et al.  Disagreement in patient and carer assessment of functional abilities after stroke. , 1999, Stroke.

[33]  S. Slørdahl,et al.  Treatment in a combined acute and rehabilitation stroke unit: which aspects are most important? , 1999, Stroke.

[34]  Pedersen,et al.  Impaired production of proinflammatory cytokines in response to lipopolysaccharide (LPS) stimulation in elderly humans , 1999, Clinical and experimental immunology.

[35]  J. Rello,et al.  C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome , 2004, Intensive Care Medicine.

[36]  D. Wade,et al.  Measurement in neurological rehabilitation. , 1992, Current opinion in neurology and neurosurgery.

[37]  J. Drennan,et al.  Quality of life of patients on haemodialysis for end-stage renal disease. , 2005, Journal of advanced nursing.

[38]  M. Resnick,et al.  The epidemiology of incontinence in the elderly. , 1998, British journal of urology.

[39]  Y. Hokama,et al.  Potential clinical applications of c‐reactive protein , 1990, Journal of clinical laboratory analysis.

[40]  A. Rudd,et al.  Real-time measurement of serum C-reactive protein in the management of infection in the elderly. , 1986, Age and ageing.

[41]  J. Addington-hall,et al.  Living with and dying from heart failure: the role of palliative care , 2002, Heart.

[42]  Kerenza Hood,et al.  Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial , 2009, BMJ : British Medical Journal.

[43]  R. Woodman,et al.  Racial disparities in infection‐related mortality at Alice Springs Hospital, Central Australia, 2000–2005 , 2008, The Medical journal of Australia.

[44]  J. Lacroix,et al.  Procalcitonin and C-reactive protein as markers of bacterial infection in critically ill children at onset of systemic inflammatory response syndrome* , 2008, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[45]  P. Francioli,et al.  Infections and Functional Impairment in Nursing Home Residents: A Reciprocal Relationship , 2004, Journal of the American Geriatrics Society.

[46]  E. Polati,et al.  Comparison of procalcitonin and C-reactive protein as markers of sepsis. , 2003, Critical care medicine.

[47]  C. March,et al.  cDNA expression cloning of the IL-1 receptor, a member of the immunoglobulin superfamily. , 1988, Science.

[48]  Dianxu Ren,et al.  Systemic Inflammatory Markers, Periodontal Diseases, and Periodontal Infections in an Elderly Population , 2005, Journal of the American Geriatrics Society.

[49]  K. Abromeit.  Music Received , 2023, Notes.

[50]  M. Greenstone,et al.  How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer , 2000, Thorax.

[51]  N. Soni,et al.  C-reactive protein as an indicator of resolution of sepsis in the intensive care unit , 1995, Intensive Care Medicine.

[52]  M. Goldacre,et al.  Case fatality rates after admission to hospital with stroke: linked database study , 2003, BMJ : British Medical Journal.

[53]  J. Bestall,et al.  The use of cognitive interviewing methodology in the design and testing of a screening tool for supportive and palliative care needs , 2009, Supportive Care in Cancer.

[54]  T. D. Du Clos.  Function of C-reactive protein , 2000, Annals of medicine.

[55]  R. W. Berg,et al.  Association of Skin Wetness and pH With Diaper Dermatitis , 1994, Pediatric dermatology.

[56]  P. Roderick,et al.  The impact of stroke on informal carers: a literature review. , 1999, Social science & medicine.

[57]  T. Wyller,et al.  Is the concentration of C-reactive protein in bacteraemia associated with age? , 2008, Immunity & Ageing.

[58]  E. Glader,et al.  Poststroke Fatigue: A 2-Year Follow-Up Study of Stroke Patients in Sweden , 2002, Stroke.

[59]  J. Wyman,et al.  Prevalence and Correlates of Perineal Dermatitis in Nursing Home Residents , 2006, Nursing research.

[60]  M. Hotopf,et al.  Depression in advanced disease: a systematic review Part 1. Prevalence and case finding , 2002, Palliative medicine.

[61]  P. Abrams,et al.  Hydration monitoring in the prevention of recurrent idiopathic urinary tract infections in pre-menopausal women. , 1995, British journal of urology.

[62]  J. Aldridge,et al.  Care of the dying: setting standards for symptom control in the last 48 hours of life. , 2001, Journal of pain and symptom management.

[63]  M. Levy,et al.  2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference , 2003, Intensive care medicine.