Observational studyMedicine2019
Septic patients presenting with apparently normal C-reactive protein: A point of caution for the ER physician.
Observational study in Medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed.
- Hexosylceramide Species in the Blood Decline in Both COVID-19 and Non-COVID-19 Sepsis.Biomedicines · 2026Article
- Extracellular vesicle proteomics in staphylococcus aureus-treated blood and sepsis reveals coordinated complement, acute phase, neutrophil, and exocytosis responses.Scientific reports · 2026Article
- Diagnostic superiority of serial increase in C-reactive protein versus single measurement in differentiating bacterial from non-bacterial etiologies in pediatric patients.Paediatrics & child health · 2025Article
- Characterizing CRP dynamics during acute infections.Infection · 2025Article
- Determinants of CRP measurements and CRP dynamics during early neonatal sepsis work up.Scientific reports · 2025Article
- Blood from septic patients with necrotising soft tissue infection treated with hyperbaric oxygen reveal different gene expression patterns compared to standard treatment.BMC medical genomics · 2025Observational
- Harnessing the host response for precision infectious disease diagnosis.Clinical microbiology reviews · 2024Review
- Article
- C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation.International journal of molecular sciences · 2022Review
- Epidemiology and Factors Associated With Discharging Patients After Blood Culture Collection in the Emergency Department: A Case-Control Study in Japan.Open forum infectious diseases · 2022Article
- Sepsis Related Mortality Associated with an Inflammatory Burst in Patients Admitting to the Department of Internal Medicine with Apparently Normal C-Reactive Protein Concentration.Journal of clinical medicine · 2022Article
- Monocyte distribution width as part of a broad pragmatic sepsis screen in the emergency department.Journal of the American College of Emergency Physicians open · 2022Article
- Two New Neutrophil Subsets Define a Discriminating Sepsis Signature.American journal of respiratory and critical care medicine · 2022Observational
- C-reactive protein velocity discriminates between acute viral and bacterial infections in patients who present with relatively low CRP concentrations.BMC infectious diseases · 2021Article
- Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE, a prospective observational study.Archives of disease in childhood · 2021Observational
- Host Diagnostic Biomarkers of Infection in the ICU: Where Are We and Where Are We Going?Current infectious disease reports · 2021Review
- Observational
Corrections and comments
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The presentation of septic patients with low C-reactive protein (CRP) concentrations to the emergency room (ER) might convey an erroneous impression regarding the severity of the disease.We analyzed a retrospective study of septic patients admitted to the internal medicine departments of a relatively large tertiary medical center, following admission to the ER. These patients had CRP concentrations of <31.9 mg/L, the determined cut-off for CRP concentrations in a large cohort of apparently healthy individuals in the community (n = 17,214, upper limit of mean + 3 standard deviations).By processing the electronic medical records, we found 2724 patients with a diagnosis of sepsis, 476 of whom had an admission CRP concentration of <31.9 mg/L. Following further analysis of these records, we found that 34 of the 175 patients (19.4%) who fulfilled the definition of sepsis, died within 1 week of hospitalization. Of special interest was the finding that within <24 h, a significant increment from a median CRP of 16.1 mg/L (IQR 7.9-22.5) to 58.6 mg/L (IQR 24.2-134.4), (P < .001) was noted, accompanied by a velocity change from 0.4 ± 0.29 to 8.3 ± 24.2 mg/L/h following antibiotic administration (P < .001).ER physicians should take into consideration that septic patients with a high in-hospital mortality rate can present with CRP concentrations that are within the range observed in apparently healthy individuals in the community. A second CRP test obtained within 24 h following antibiotic administration might influence attitudes regarding the severity of the disease.
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