Characterizing CRP dynamics during acute infections.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES Infection Pub Date : 2024-10-28 DOI:10.1007/s15010-024-02422-7

Stacey S Cherny, Rafael Y Brzezinski, Asaf Wasserman, Amos Adler, Shlomo Berliner, Daniel Nevo, Saharon Rosset, Uri Obolski

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Abstract

Purpose: C-reactive protein (CRP) is a common proxy of inflammation, but accurate characterizations of its dynamics during acute infections are scant. The goal of this study was to examine C-reactive protein (CRP) trajectories in hospitalized patients with viral infections, confirmed bacteremia (stratified by Gram-negative or Gram-positive bacteria), and non-bacteremic infections/inflammations, considering antibiotic treatment.

Methods: Electronic medical records from Tel Aviv Sourasky Medical Center (July 2007-May 2023) were analyzed. Patients with blood cultures or positive viral tests were included. CRP levels were modeled using generalized additive mixed-effects models (GAMMs) and observed up to 150 h after initial infection diagnosis. Patients with initial CRP levels > 31.9 were excluded, to remove individuals already in a highly active inflammatory process. The shapes of the CRP curves were characterized and peak CRP as well as area under the CRP curve were the primary variables of interest.

Results: Viral infections had the lowest and flattest CRP curves. Non-bacteremic infections showed intermediate levels, while bacteremia (especially Gram-negative under antibiotic treatment) had the highest CRP peaks. For instance, peak CRP ranged from 15.4 mg/L in viral infections without antibiotics to 140.9 mg/L in Gram-negative bacteremia with antibiotics.

Conclusions: CRP trajectories significantly differ based on infection type and antibiotic treatment. Frequent CRP measurement could be a valuable diagnostic and risk stratification tool in hospitalized patients.

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描述急性感染期间 CRP 的动态特征。

目的：C-反应蛋白（CRP）是炎症的常见替代物，但准确描述其在急性感染期间的动态特征却很少。本研究的目的是在考虑抗生素治疗的情况下，研究住院病毒感染、确诊菌血症（按革兰氏阴性菌或革兰氏阳性菌分层）和非菌血症感染/炎症患者的 C 反应蛋白（CRP）变化轨迹：分析特拉维夫苏拉斯基医疗中心的电子病历（2007 年 7 月至 2023 年 5 月）。纳入了血液培养或病毒检测呈阳性的患者。使用广义加性混合效应模型（GAMMs）对 CRP 水平进行建模，并观察初始感染诊断后 150 小时内的 CRP 水平。排除了初始 CRP 水平大于 31.9 的患者，以去除已经处于高度活跃炎症过程中的个体。对 CRP 曲线的形状进行了分析，CRP 峰值和 CRP 曲线下面积是主要的关注变量：结果：病毒感染的 CRP 曲线最低且最平坦。结果显示：病毒感染的 CRP 曲线最低且最平坦，非菌血症感染的 CRP 曲线处于中间水平，而菌血症（尤其是接受抗生素治疗的革兰氏阴性菌）的 CRP 峰值最高。例如，CRP峰值从未用过抗生素的病毒感染的15.4毫克/升到用过抗生素的革兰氏阴性菌血症的140.9毫克/升不等：结论：CRP的变化轨迹因感染类型和抗生素治疗的不同而明显不同。经常测量 CRP 可以作为住院患者的诊断和风险分层工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.