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  • Title: C-reactive protein to distinguish pneumonia from acute decompensated heart failure.
    Author: Joffe E, Justo D, Mashav N, Swartzon M, Gur H, Berliner S, Paran Y.
    Journal: Clin Biochem; 2009 Nov; 42(16-17):1628-34. PubMed ID: 19703436.
    Abstract:
    BACKGROUND: Patients with acute decompensated heart failure (ADHF) are frequently treated with unnecessary antibiotics since they are confused with pneumonia patients. AIM: To study the efficacy of measuring C-reactive protein (CRP) levels on admission and CRP velocity in differentiating ADHF from pneumonia. METHODS: A retrospective observational study of ADHF and pneumonia patients admitted to a tertiary hospital during 2 years. Patients who were already treated with antibiotics on admission were excluded. Efficacy of CRP as a diagnostic marker was evaluated by using receiver operator curves (ROC). RESULTS: Overall, 72 ADHF and 50 pneumonia patients were included in the study. The mean CRP levels on admission were 13.5+/-13.5 mg/L for the ADHF patients and 127+/-84 mg/L for the pneumonia patients (p<0.001). CRP increases of > or =0.56 mg/L/h were diagnostic of pneumonia. CRP levels on admission together with CRP increases had a sensitivity of 0.96 and a specificity of 0.972 (p<0.001) as markers to distinguish pneumonia from ADHF. CONCLUSIONS: This study emphasizes the dynamic nature of biomarkers. Demonstrating the efficiency of repeated CRP measurements in an acute setting will provide clinicians with a valuable tool for establishing the correct diagnosis and refraining from unnecessary use of antibiotics.
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