Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough.
OBJECTIVE
To evaluate the performance of a rapid, bedside whole blood C-reactive protein test as a diagnostic test for pneumonia in adults.


METHODS
We enrolled consecutive adults who presented with acute cough (duration < or =3 weeks). A fingerstick blood specimen for C-reactive protein level was obtained. Patients also provided information about demographic characteristics and symptoms. Physical examination findings, diagnoses, and treatments were abstracted from the medical record; illness duration and subsequent office visits were determined with follow-up telephone calls. A clinical prediction rule for pneumonia was calculated for each patient and compared with C-reactive protein levels.


RESULTS
Twenty (12%) of the 168 patients in the study had radiographic evidence of pneumonia. Median C-reactive protein levels were significantly higher for patients with pneumonia than in the remaining patients (60 mg/L vs. 9 mg/L, P <0.0001). The area under the receiver operating characteristic (ROC) curve for C-reactive protein level as a predictor of pneumonia was 0.83. C-reactive protein level and the clinical prediction rule were independently associated with pneumonia, yielding a combined area under the ROC curve of 0.93. C-reactive protein level was not associated with hospitalization or resolution of symptoms.


CONCLUSIONS
C-reactive protein levels could be a valuable addition to clinical prediction rules for pneumonia. A C-reactive protein level > or =100 mg/L might be a useful indication for chest radiography or empiric antibiotic therapy when the diagnosis of pneumonia is in doubt.
Flanders
Scott A
SA
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco 94118, USA.
Stein
John
J
Shochat
Guy
G
Sellers
Karen
K
Holland
Miles
M
Maselli
Judith
J
Drew
W Lawrence
WL
Reingold
Art L
AL
Gonzales
Ralph
R
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D017714:Community-Acquired Infections / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D003371:Cough / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D012372:ROC Curve
D002097:C-Reactive Protein