Clinical research studyC-Reactive Protein Is an Independent Predictor of Severity in Community-acquired Pneumonia
Section snippets
Methods
We conducted a prospective study of all adult patients admitted between February 2005 and February 2007 with a primary diagnosis of community-acquired pneumonia. Ethical approval was obtained from the Lothian research ethics committee.
The main inclusion criteria were presentation to hospital with a diagnosis of community-acquired pneumonia within the study period (February 2005 to February 2007) and the absence of any exclusion criteria. Community-acquired pneumonia was defined as a history
Results
There were 936 patients considered for inclusion during the study period; 570 patients met the criteria and were included in the study. Reasons for exclusion are shown in Table 2.
Baseline characteristics of the study population are shown in Table 3. Characteristics are shown for the whole population and for those patients who had repeat C-reactive protein measurements available during the first 4 days of treatment.
Of all patients, 20.7% were discharged within 24 hours of admission; 13.5%
Discussion
In this study, low CRP levels (<100 mg/L) have high negative predictive values in excluding 30-day mortality, requirement for invasive ventilation and/or inotropic support, and complicated pneumonia. In addition, repeat measurement of CRP at day 4 is shown to be a powerful marker of treatment response—patients in whom the CRP level falls by 50% or more in 4 days have low rates of 30-day mortality, requirement for invasive ventilation and/or inotropic support, and development of complicated
Conclusion
Low admission C-reactive protein levels <100 mg/L effectively excludes severe community-acquired pneumonia and can be used as an adjunct to clinical judgment to identify low-risk patients who may be safely discharged. C-reactive protein <100 mg/L provides a high negative predictive value comparable with CURB65 and PSI severity rules. In patients admitted to the hospital, a CRP level that falls by 50% or more in 4 days indicates a low risk of 30-day mortality, need for mechanical ventilation
References (20)
- et al.
The cost of treating community-acquired pneumonia
Clin Ther
(1998) - et al.
C-reactive proteinA clinical marker in community-acquired pneumonia
Chest
(1995) - et al.
C-reactive protein levels correlate with mortality and organ failure in critically ill patients
Chest
(2003) - et al.
Hydrocortisone and tumor necrosis factor in severe community acquired pneumoniaA randomised controlled study
Chest
(1993) - et al.
Community-acquired pneumonia: aetiology and usefulness of severity criteria on admission
Thorax
(1996) - et al.
Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study
Thorax
(2003) - et al.
A prediction rule to identify low-risk patients with community-acquired pneumonia
N Engl J Med
(1997) - et al.
C-reactive protein levels in community-acquired pneumonia
Eur Respir J
(2003) Guidelines for the Management of Community Acquired Pneumonia in Adults—2004 Update
(2004)- et al.
Sequential changes of inflammatory and nutritional markers in patients with community-acquired pneumonia
Scand J Clin Lab Invest
(1997)