Evidence map›Paper›PMID 31208975›Full record

ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2019

Use of multiple inflammatory marker tests in primary care: using Clinical Practice Research Datalink to evaluate accuracy.

Jessica Watson, Hayley E Jones, Jonathan Banks, Penny Whiting, Chris Salisbury, Willie Hamilton

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In one paragraph

Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  8. How much evidence is needed before additional testing is incentivised at scale?The British journal of general practice : the journal of the Royal College of General Practitioners · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Jessica WatsonPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Hayley E JonesPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Jonathan BanksPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Penny WhitingPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Chris SalisburyPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Willie HamiltonUniversity of Exeter Medical School, University of Exeter, Exeter.

Funding

Department of Health DRF-2016-09-034Medical Research Council MR/M014533/1
6 · The paper itself

Abstract

backgroundResearch comparing C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and plasma viscosity (PV) in primary care is lacking. Clinicians often test multiple inflammatory markers, leading to concerns about overuse.

aimTo compare the diagnostic accuracies of CRP, ESR, and PV, and to evaluate whether measuring two inflammatory markers increases accuracy. DESIGN AND

settingProspective cohort study in UK primary care using the Clinical Practice Research Datalink.

methodThe authors compared diagnostic test performance of inflammatory markers, singly and paired, for relevant disease, defined as any infections, autoimmune conditions, or cancers. For each of the three tests (CRP, ESR, and PV), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operator curve (AUC) were calculated.

resultsParticipants comprised 136 961 patients with inflammatory marker testing in 2014; 83 761 (61.2%) had a single inflammatory marker at the index date, and 53 200 (38.8%) had multiple inflammatory markers. For

conclusionTesting multiple inflammatory markers simultaneously does not increase ability to rule out disease and should generally be avoided. CRP has marginally superior diagnostic accuracy for infections, and is equivalent for autoimmune conditions and cancers, so should generally be the first-line test.

Indexed as

Blood SedimentationViscosityAdultAgedArea Under CurveAutoimmune DiseasesCohort StudiesC-Reactive ProteinFemaleHumansInfectionsInflammationMaleMiddle AgedNeoplasmsPlasmaC-Reactive Proteinblood plasmablood testsc-reactive proteinerythrocyte sedimentation rateprimary care

Identifiers

PMID31208975
PMCPMC6582449

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.