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C-reactive protein is more sensitive than erythrocyte sedimentation rate for diagnosis of infective endocarditis
H Hogevik1, L Olaison, R Andersson
1Dept. of Infectious Diseases, Göteborg University, Ostra University Hospital, Sweden.
Insights
C-reactive protein (CRP) is more sensitive than erythrocyte sedimentation rate (ESR) and other markers for diagnosing infective endocarditis (IE). This study found CRP to be a superior diagnostic tool for IE in adults.
Area of Science:
- Infectious Diseases
- Clinical Chemistry
- Hematology
Background:
- Infective endocarditis (IE) is a serious infection requiring accurate and timely diagnosis.
- Biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leucocyte count, and thrombocyte count are used to aid in IE diagnosis.
- Evaluating the comparative sensitivity of these markers is crucial for optimizing diagnostic strategies.
Purpose of the Study:
- To compare the diagnostic sensitivity of C-reactive protein (CRP) elevation against erythrocyte sedimentation rate (ESR), leucocyte count, and thrombocyte count in suspected cases of infective endocarditis (IE).
- To identify factors influencing CRP levels in patients with IE.
Main Methods:
- A prospective study was conducted on adult patients with suspected IE in a tertiary care setting.
- Data on CRP, ESR, leucocyte count, and thrombocyte count were collected at the start of treatment for 89 confirmed IE episodes.
- Patient demographics, clinical characteristics, and laboratory values were analyzed.
Main Results:
- C-reactive protein (CRP) demonstrated high sensitivity, with only 4% of IE episodes showing normal levels (median 90 mg/l).
- CRP levels were significantly higher in episodes involving native valves, staphylococcal origin, shorter symptom duration, and higher fever.
- CRP elevation was also prominent in patients over 70 years old.
- Erythrocyte sedimentation rate (ESR) was less sensitive, with 28% of episodes having normal levels.
Conclusions:
- C-reactive protein (CRP) determination is superior to erythrocyte sedimentation rate (ESR), leucocyte count, and thrombocyte count for diagnosing infective endocarditis (IE).
- CRP is a valuable and sensitive biomarker for IE diagnosis, particularly in specific patient subgroups and clinical presentations.
Abstract:
The objective of this study was to evaluate the sensitivity of C-reactive protein (CRP) elevation compared to erythrocyte sedimentation rate (ESR), leucocyte count and thrombocyte count in the diagnosis of infective endocarditis (IE). It was designed as a prospective study of suspected episodes of IE in adults in tertiary care at a university-affiliated department of infectious diseases. In 89 episodes of IE, CRP was available from the start of treatment. Median age was 66 years, 45 were men and 44 women. Median CRP concentration was found to be 90 (range 0-357) mg/l with only 4% normal values. Episodes involving native valves had higher CRP than episodes occurring with prosthetic valves. Staphylococcal origin, short duration of symptoms, short duration of fever and highest recorded temperature all correlated to higher CRP levels. The CRP response was also prominent among patients > 70 years old. Among non-responders, a few cases with simultaneous cirrhosis were noted. ESR was less sensitive than CRP, with a normal level in 28% of the episodes. It was concluded that CRP determination is superior to erythrocyte sedimentation rate, leucocyte count and thrombocyte count in the diagnosis of infective endocarditis.