Clinical Investigation
Diagnostic and Prognostic Significance of Serum C-Reactive Protein Levels in Patients Admitted to the Department of Medicine

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Abstract

Background

Despite its apparent role as a marker of different disease processes, to date, no study has presented comprehensive comparative data regarding the distribution of serum C-reactive protein (CRP) levels in all admitted patients. We aimed to examine the distribution of serum CRP levels in internal medicine patients and to find whether initial serum CRP value had a diagnostic and prognostic significance.

Methods

Serum CRP levels together with epidemiologic, clinical, and laboratory data were analyzed for 370 consecutive adult patients admitted to the department of internal medicine during a 2-month period.

Results

The median CRP level on admission was 24 mg/L, with a range between 0 and 346 mg/L. Infections had significantly higher median CRP than noninfections (99 versus 11 mg/L), and bacterial infections had distinctively higher CRP (120 mg/L) compared with nonbacterial infections (32 mg/L). The highest noninfectious median CRP was recorded in inflammatory bowel disease exacerbation (107 mg/L). Moreover, serum CRP was divided into 5 ranges. Very high CRP >200 mg/L was a marker of sepsis. In contrast, low CRP range (<10 mg/L) was characteristic to cardiovascular diseases and viral infections, but included none of the patients with severe infections or sepsis. Furthermore, higher CRP was significantly associated with mortality, the need for intubation, and longer hospitalization, and had better distinguishing ability compared with erythrocyte sedimentation rate or platelets count for the comparison of major disease categories, such as bacterial infections, inflammatory and rheumatic disease, viral infections, and cardiovascular disorders.

Conclusions

Initial serum CRP has an important role as a diagnostic and prognostic tool in patients admitted to internal medicine.

Section snippets

Setting

This analysis was conducted in Tel Aviv Souraski Medical Center, which is the major community and tertiary care University Hospital in Tel Aviv (1150 beds).

Patients

Five hundred fourteen adult (age ≥18 years) patients were admitted to the Department of Internal Medicine B during the 2-month period of the analysis. One hundred forty-four patients were excluded, including patients who were transferred from another department, who had been mechanically ventilated before admission, after significant trauma

Epidemiologic and Clinical Data

Three hundred seventy patients were included in the study. General epidemiologic and clinical data are presented in Table 1 and the main laboratory data are presented in Table 2. The leading cause of admission was infectious disease (Table 3), present in 144 admitted patients (39%). Other frequent diagnoses were nonischemic CVS disease and chest pain for observation. As shown in Table 4, the most common infections were viral infection and pneumonia. Sepsis was present in 39 of 144 (27%) of the

DISCUSSION

Despite numerous studies on serum CRP as a marker of inflammation and prognosis in specific situations and various disease states,4., 5., 6., 7., 8., 9., 10., 11., 12., 13. the current study was unique, and, to the best of our knowledge, the first in providing direct comparison of serum CRP among a cohort of all consecutive medical in-hospital patients.

The data show that despite the high variability and overlap of serum CRP in the various diagnoses, the initial CRP has an ability to

ACKNOWLEDGMENT

We thank Doron Comaneshter, PhD, for his excellent statistical work.

REFERENCES (21)

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RK and BB equally contributed to the study and manuscript.

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