Prognostic utility of serum CRP levels in combination with CURB-65 in patients with clinically suspected sepsis: a decision curve analysis.
OBJECTIVE
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.


METHODS
Retrospective cohort study.


METHODS
Emergency department (ED) of an urban teaching hospital in Japan.


METHODS
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.


METHODS
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.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Shungo
S
Yamamoto
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Shin
S
Yamazaki
Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan.
Tsunehiro
T
Shimizu
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
Taro
T
Takeshima
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
Shingo
S
Fukuma
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Yosuke
Y
Yamamoto
Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan.
Kentaro
K
Tochitani
Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan.
Yasuhiro
Y
Tsuchido
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Koh
K
Shinohara
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
Shunichi
S
Fukuhara
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D003221:Confusion / Q000453:epidemiology*; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D056152:Respiratory Rate; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality*
D002097:C-Reactive Protein
INFECTIOUS DISEASES; PRIMARY CARE; STATISTICS & RESEARCH METHODS