CRP under 130 mg/L rules out the diagnosis of Legionella pneumophila serogroup 1 (URINELLA Study).

Autor: Klopfenstein T; Infectious Diseases and Tropical Department, Nord Franche-Comté Hospital, 90400, Trevenans, France. timothee.klopfenstein@hnfc.fr., Zayet S; Infectious Diseases and Tropical Department, Nord Franche-Comté Hospital, 90400, Trevenans, France., Poloni S; Infectious Diseases and Tropical Department, Besançon University Hospital, Besançon, France., Gendrin V; Infectious Diseases and Tropical Department, Nord Franche-Comté Hospital, 90400, Trevenans, France., Fournier D; Bacteriology Laboratory, Besançon University Hospital, Besançon, France., Vuillemenot JB; Bacteriology Laboratory, Nord Franche-Comté Hospital, Trevenans, France., Selles P; Medical Information Department, Nord Franche-Comté Hospital, Trevenans, France., Dussaucy A; Medical Information Department, Besançon University Hospital, Besançon, France., Coureau G; University of Bordeaux, Population Health Research Center, UMR U1219, INSERM, Bordeaux, France., Avalos-Fernandez M; University of Bordeaux, Population Health Research Center, UMR U1219, INSERM, Bordeaux, France., Toko L; Infectious Diseases and Tropical Department, Nord Franche-Comté Hospital, 90400, Trevenans, France., Royer PY; Infectious Diseases and Tropical Department, Nord Franche-Comté Hospital, 90400, Trevenans, France., Lavoignet CE; Emergency Department, Nord Franche-Comté Hospital, Trevenans, France., Amari B; University of Bordeaux, Population Health Research Center, UMR U1219, INSERM, Bordeaux, France., Puyraveau M; Methodology Unit, Clinical Investigation Center INSERM 1431, Besançon University Hospital, Besançon, France., Chirouze C; Infectious Diseases and Tropical Department, Besançon University Hospital, Besançon, France.; UMR-CNRS 6249 Chrono-Environnement, Department of Infectious and Tropical Diseases, Université de Franche-Comté, CHU Besançon, 25000, Besançon, France.
Jazyk: angličtina
Zdroj: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology [Eur J Clin Microbiol Infect Dis] 2024 Jun; Vol. 43 (6), pp. 1051-1059. Date of Electronic Publication: 2024 Mar 26.
DOI: 10.1007/s10096-024-04814-x
Abstrakt: Introduction: In case of pneumonia, some biological findings are suggestive for Legionnaire's disease (LD) including C-reactive protein (CRP). A low level of CRP is predictive for negative Legionella Urinary-Antigen-Test (L-UAT).
Method: Observational retrospective study in Nord-Franche-Comté Hospital with external validation in Besançon University Hospital, France which included all adults with L-UAT performed during January 2018 to December 2022. The objective was to determine CRP optimal threshold to predict a L-UAT negative result.
Results: URINELLA included 5051 patients (83 with positive L-UAT). CRP optimal threshold was 131.9 mg/L, with a negative predictive value (NPV) at 100%, sensitivity at 100% and specificity at 58.0%. The AUC of the ROC-Curve was at 88.7% (95% CI, 86.3-91.1). External validation in Besançon Hospital patients showed an AUC at 89.8% (95% CI, 85.5-94.1) and NPV, sensitivity and specificity was respectively 99.9%, 97.6% and 59.1% for a CRP threshold at 131.9 mg/L; after exclusion of immunosuppressed patients, index sensitivity and NPV reached also 100%.
Conclusion: In case of pneumonia suspicion with a CRP level under 130 mg/L (independently of the severity) L-UAT is useless in immunocompetent patients with a NPV at 100%. We must remain cautious in patients with symptoms onset less than 48 h before CRP dosage.
(© 2024. The Author(s).)
Databáze: MEDLINE
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