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Title: Prognostic utility of serum CRP levels in combination with CURB-65 in patients with clinically suspected sepsis: a decision curve analysis
Authors: Yamamoto, S.
Yamazaki, S.
Shimizu, T.
Takeshima, T.
Fukuma, S.
Yamamoto, Y.
Tochitani, K.
Tsuchido, Y.
Shinohara, K.
Fukuhara, S.
Author's alias: 福原, 俊一
山本, 洋介
Issue Date: 28-Apr-2015
Publisher: BMJ Publishing Group
Journal title: BMJ Open
Volume: 5
Issue: 4
Thesis number: e007049
Abstract: [Objectives] The prognostic utility of serum C reactive protein (CRP) alone in sepsis is controversial. We used decision curve analysis (DCA) to evaluate the clinical usefulness of combining serum CRP levels with the CUBR-65 score in patients with suspected sepsis. [Design] Retrospective cohort study. [Setting] Emergency department (ED) of an urban teaching hospital in Japan. [Participants] Consecutive ED patients over 15 years of age who were admitted to the hospital after having a blood culture taken in the ED between 1 January 2010 and 31 December 2012. [Main outcome measures] 30-day in-hospital mortality. [Results] Data from 1262 patients were analysed for score evaluation. The 30-day in-hospital mortality was 8.4%. Multivariable analysis showed that serum CRP ≥150 mg/L was an independent predictor of death (adjusted OR 2.0; 95% CI 1.3 to 3.1). We compared the predictive performance of CURB-65 with the performance of a modified CURB-65 with that included CRP (≥150 mg/L) to quantify the clinical usefulness of combining serum CRP with CURB-65. The areas under the receiver operating characteristics curves of CURB-65 and a modified CURB-65 were 0.76 (95% CI 0.72 to 0.80) and 0.77 (95% CI 0.72 to 0.81), respectively. Both models had good calibration for mortality and were useful among threshold probabilities from 0% to 30%. However, while incorporating CRP into CURB-65 yielded a significant category-free net reclassification improvement of 0.387 (95% CI 0.193 to 0.582) and integrated discrimination improvement of 0.015 (95% CI 0.004 to 0.027), DCA showed that CURB-65 and the modified CURB-65 score had comparable net benefits for prediction of mortality. [Conclusions] Measurement of serum CRP added limited clinical usefulness to CURB-65 in predicting mortality in patients with clinically suspected sepsis, regardless of the source.
Rights: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
URI: http://hdl.handle.net/2433/216068
DOI(Published Version): 10.1136/bmjopen-2014-007049
PubMed ID: 25922102
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