Vanessa Martins de Oliveira1, Rafael Barberena Moraes2, Airton Tetelbom Stein3, Eliana Márcia Wendland4. 1. Intensive Care Unit, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos Street 2350, Porto Alegre, Brazil. Electronic address: vmoliveira@hcpa.edu.br. 2. Intensive Care Unit, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos Street 2350, Porto Alegre, Brazil. Electronic address: rbmoraes@hcpa.edu.br. 3. Medical Science, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. Electronic address: airton.stein@gmail.com. 4. Epidemiology, Public Health Department, Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil. Electronic address: elianawend@gmail.com.
Abstract
BACKGROUND: There is a need for a better understanding of the role of C-reactive protein (CRP) as a valid marker for the detection of bacterial infections in critically immunosuppressed patients. A high negative predictive value of CRP is also needed to rule out sepsis and bacterial infections in immunocompetent patients. However, few studies have evaluated the performance of CRP in immunocompromised hosts. The aim of the present study was to evaluate the performance of CRP as a marker of infection in critically immunosuppressed patients. METHODS: The inclusion criterion was immunosuppression for which CRP was used as a bacterial infection marker. Searches were performed in the Cochrane Register, MEDLINE, EMBASE, SCOPUS, Web OF Science, LILACS and CINAHL databases. We applied the Quality Assessment of Diagnostic Accuracy Studies tool 2 (QUADAS 2) to evaluate the quality of the articles and evaluated the test accuracy parameters using hierarchical summary receiver operating characteristic (HSROC) curves and bivariate random effect models. RESULTS: Only 13 of 21 studies produced quantitative results. We analyzed all studies using the random effects method (restricted maximum likelihood) and obtained a joint diagnostic odds ratio (DOR) of 3.04 (95% confidence interval [CI] 1.71-5.40) with heterogeneity (I2=91%, Q=181.48, p<0.001). Therefore, a bivariate model was applied. Analyzing the tuberculosis carrier, steroid user, or presence of opportunistic infection subgroups, as described in the proposal, was not possible due to the lack of information on these topics included in the articles. CONCLUSIONS: CRP appears to be a good screening tool for sepsis in critically immunosuppressed patients. Submitted PROSPERO 2015: CRD42015019329.
BACKGROUND: There is a need for a better understanding of the role of C-reactive protein (CRP) as a valid marker for the detection of bacterial infections in critically immunosuppressed patients. A high negative predictive value of CRP is also needed to rule out sepsis and bacterial infections in immunocompetent patients. However, few studies have evaluated the performance of CRP in immunocompromised hosts. The aim of the present study was to evaluate the performance of CRP as a marker of infection in critically immunosuppressed patients. METHODS: The inclusion criterion was immunosuppression for which CRP was used as a bacterial infection marker. Searches were performed in the Cochrane Register, MEDLINE, EMBASE, SCOPUS, Web OF Science, LILACS and CINAHL databases. We applied the Quality Assessment of Diagnostic Accuracy Studies tool 2 (QUADAS 2) to evaluate the quality of the articles and evaluated the test accuracy parameters using hierarchical summary receiver operating characteristic (HSROC) curves and bivariate random effect models. RESULTS: Only 13 of 21 studies produced quantitative results. We analyzed all studies using the random effects method (restricted maximum likelihood) and obtained a joint diagnostic odds ratio (DOR) of 3.04 (95% confidence interval [CI] 1.71-5.40) with heterogeneity (I2=91%, Q=181.48, p<0.001). Therefore, a bivariate model was applied. Analyzing the tuberculosis carrier, steroid user, or presence of opportunistic infection subgroups, as described in the proposal, was not possible due to the lack of information on these topics included in the articles. CONCLUSIONS:CRP appears to be a good screening tool for sepsis in critically immunosuppressed patients. Submitted PROSPERO 2015: CRD42015019329.
Authors: Holly A Richendrfer; Mitchell M Levy; Khaled A Elsaid; Tannin A Schmidt; Ling Zhang; Ralph Cabezas; Gregory D Jay Journal: Crit Care Explor Date: 2020-06-10
Authors: Mark Berman; Ronen Ben-Ami; Shlomo Berliner; Marina Anouk; Ilana Kaufman; Adi Broyde; Sara Borok; Ori Elkayam Journal: Life (Basel) Date: 2021-03-20