The potential role of C-reactive protein in distinguishing cytomegalovirus from tuberculosis and bacterial infections in renal transplant recipients.
BACKGROUND
The delay in the diagnosis of infections can be deleterious in renal transplant recipients. Thus, laboratory tests leading to an earlier diagnosis are very useful for these patients.


OBJECTIVE
To assess the behavior of C-reactive protein (CRP) in renal transplant recipients with a diagnosis of cytomegalovirus (CMV) infection, tuberculosis (TB) and bacterial infection (BI).


METHODS
A retrospective analysis of 129 patients admitted at our hospital, from 2006 to 2008 because of CMV, TB or BI, was carried out. Appropriate statistical analysis was done and values were expressed as medians, range.


RESULTS
When CRP levels were compared among the groups with CMV disease, TB or BI, the group with CMV disease presented lower levels of CRP (18.4 mg/L, 0.28-44 mg/L) than the TB and BI (p < 0.05) groups. The area under the receiver-operating characteristics curve, distinguishing CMV disease from TB/BI, was 0.96 (p < 0.0001), resulting in 100% sensitivity and 90.63% specificity to detect CMV disease when CRP < 44.5 mg/L. The subgroup analysis of CMV infection showed increasing levels of CRP (0.28, 16 and 29.5 mg/L) in the asymptomatic, symptomatic and invasive disease subgroups, respectively (p < 0.05).


CONCLUSIONS
The measurement of CRP levels may be a useful tool for differentiating CMV infection from the other types (bacterial or TB) of infection in kidney transplant recipients.
Costalonga
Elerson C
EC
Renal Transplant Unit, Urological Division, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Melo
Natalia C V
NC
Rodrigues
Camila E
CE
Sette
Luis H B C
LH
Ianhez
Luiz E
LE
D000293:Adolescent; D000328:Adult; D000368:Aged; D001419:Bacteria / Q000472:pathogenicity; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D009161:Mycobacterium / Q000472:pathogenicity; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000097:blood / Q000175:diagnosis*; D055815:Young Adult
D015415:Biomarkers; D002097:C-Reactive Protein