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C-reactive protein or procalcitonin combined with rhinorrhea for discrimination of viral from bacterial infections in hospitalized adults in non-intensive care units with lower respiratory tract infections.
Duan, Shengchen; Gu, Xiaoying; Fan, Guohui; Zhou, Fei; Zhu, Guangfa; Cao, Bin.
  • Duan S; Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  • Gu X; Department of Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
  • Fan G; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.
  • Zhou F; National Clinical Research Center of Respiratory Diseases, Beijing, China.
  • Zhu G; Department of Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
  • Cao B; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.
BMC Pulm Med ; 21(1): 308, 2021 Sep 28.
Article in English | MEDLINE | ID: covidwho-1439539
ABSTRACT

BACKGROUND:

Whether procalcitonin (PCT) or C-reactive protein (CRP) combined with certain clinical characteristics can better distinguish viral from bacterial infections remains unclear. The aim of the study was to assess the ability of PCT or CRP combined with clinical characteristics to distinguish between viral and bacterial infections in hospitalized non-intensive care unit (ICU) adults with lower respiratory tract infection (LRTI).

METHODS:

This was a post-hoc analysis of a randomized clinical trial previously conducted among LRTI patients. The ability of PCT, CRP and PCT or CRP combined with clinical symptoms to discriminate between viral and bacterial infection were assessed by portraying receiver operating characteristic (ROC) curves among patients with only a viral or a typical bacterial infection.

RESULTS:

In total, 209 infected patients (viral 69%, bacterial 31%) were included in the study. When using CRP or PCT to discriminate between viral and bacterial LRTI, the optimal cut-off points were 22 mg/L and 0.18 ng/mL, respectively. When the optimal cut-off for CRP (≤ 22 mg/L) or PCT (≤ 0.18 ng/mL) combined with rhinorrhea was used to discriminate viral from bacterial LRTI, the AUCs were 0.81 (95% CI 0.75-0.87) and 0.80 (95% CI 0.74-0.86), which was statistically significantly better than when CRP or PCT used alone (p < 0.001). When CRP ≤ 22 mg/L, PCT ≤ 0.18 ng/mL and rhinorrhea were combined, the AUC was 0.86 (95% CI 0.80-0.91), which was statistically significantly higher than when CRP (≤ 22 mg/L) or PCT (≤ 0.18 ng/mL) was combined with rhinorrhea (p = 0.011 and p = 0.021).

CONCLUSIONS:

Either CRP ≤ 22 mg/L or PCT ≤ 0.18 ng/mL combined with rhinorrhea could help distinguish viral from bacterial infections in hospitalized non-ICU adults with LRTI. When rhinorrhea was combined together, discrimination ability was further improved.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Tract Infections / Virus Diseases / C-Reactive Protein / Procalcitonin / Rhinorrhea Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: BMC Pulm Med Year: 2021 Document Type: Article Affiliation country: S12890-021-01672-7

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Tract Infections / Virus Diseases / C-Reactive Protein / Procalcitonin / Rhinorrhea Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: BMC Pulm Med Year: 2021 Document Type: Article Affiliation country: S12890-021-01672-7