Tal Levinson1,2,3, Natalie Tamir1,3, Shani Shenhar-Tsarfaty1,3, Yael Paran2,3, David Zeltzer1,3, Itzhak Shapira1,3, Pinchas Halpern3,4, Ahuva Meilik3,5, Eli Raykhshtat3,5, Ilana Goldiner3,6, Amos Adler3,7, Shlomo Berliner1,3, Ori Rogowski1,3, Asaf Wasserman1,2,3. 1. Department of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 2. Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 5. Data Science and Quality Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 6. Clinical Laboratory Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 7. Clinical Microbiology Laboratory, The Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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.
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.
Entities:
Keywords:
C-reactive protein; cytokines; department of emergency medicine; gram-negative bacteraemia; inflammation