The added value of C-reactive protein measurement in diagnosing pneumonia in primary care:a meta-analysis of individual patient data
| Autor: | AW Graffelman, Geert-Jan Dinant, Arie Knuistingh Neven, Anette Holm, Alma C van de Pol, Joris A. H. de Groot, Ralph Gonzales, Hasse Melbye, Niek J. de Wit, Margaretha C. Minnaard, Saskia F. de Vries-van Vugt, Theo J M Verheij, Berna D L Broekhuizen, Alwin Schierenberg, Johann Steurer, Johannes B. Reitsma, Rogier M. Hopstaken, Timothy H. Rainer |
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| Přispěvatelé: | Family Medicine, RS: CAPHRI - R5 - Optimising Patient Care, University of Zurich, Minnaard, Margaretha C |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty SYMPTOMS ACCURACY 030106 microbiology MEDLINE 610 Medicine & health 2700 General Medicine Medical and Health Sciences Procalcitonin 7.3 Management and decision making 03 medical and health sciences 0302 clinical medicine Community-acquired pneumonia Clinical Research Internal medicine Lower respiratory tract infection General & Internal Medicine INFECTION medicine Journal Article 030212 general & internal medicine Intensive care medicine PROCALCITONIN Lung screening and diagnosis business.industry Research Area under the curve LOWER RESPIRATORY-TRACT COMMUNITY-ACQUIRED PNEUMONIA SEARCH STRATEGIES Pneumonia General Medicine PERFORMANCE medicine.disease Detection Infectious Diseases Meta-analysis Cohort Pneumonia & Influenza Management of diseases and conditions 10029 Clinic and Policlinic for Internal Medicine CLINICAL-PREDICTION business 4.2 Evaluation of markers and technologies ACUTE COUGH |
| Zdroj: | Minnaard, M C, de Groot, J A H, Hopstaken, R M, Schierenberg, A, de Wit, N J, Reitsma, J B, Broekhuizen, B D L, van Vugt, S F, Knuistingh Neven, A, Graffelman, A W, Melbye, H, Rainer, T H, Steurer, J, Holm, A, Gonzales, R, Dinant, G-J, van de Pol, A C & Verheij, T J M 2017, ' The added value of C-reactive protein measurement in diagnosing pneumonia in primary care : a meta-analysis of individual patient data ', CMAJ : Canadian Medical Association Journal, vol. 189, no. 2, pp. E56-E63 . https://doi.org/10.1503/cmaj.151163 CMAJ, 189(2), E56-E63. Canadian Medical Association CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, vol 189, iss 2 Canadian Medical Association Journal, 189(2), E56. Canadian Medical Association |
| ISSN: | 0820-3946 |
| DOI: | 10.1503/cmaj.151163 |
| Popis: | BACKGROUND: C-reactive protein (CRP) is increasingly being included in the diagnostic work-up for community-acquired pneumonia in primary care. Its added diagnostic value beyond signs and symptoms, however, remains unclear. We conducted a meta-analysis of individual patient data to quantify the added value of CRP measurement.METHODS: We included studies of the diagnostic accuracy of CRP in adult outpatients with suspected lower respiratory tract infection. We contacted authors of eligible studies for inclusion of data and for additional data as needed. The value of adding CRP measurement to a basic signs-and-symptoms prediction model was assessed. Outcome measures were improvement in discrimination between patients with and without pneumonia in primary care and improvement in risk classification, both within the individual studies and across studies.RESULTS: Authors of 8 eligible studies (n = 5308) provided their data sets. In all of the data sets, discrimination between patients with and without pneumonia improved after CRP measurement was added to the prediction model (extended model), with a mean improvement in the area under the curve of 0.075 (range 0.02-0.18). In a hypothetical cohort of 1000 patients, the proportion of patients without pneumonia correctly classified at low risk increased from 28% to 36% in the extended model, and the proportion with pneumonia correctly classified at high risk increased from 63% to 70%. The number of patients with pneumonia classified at low risk did not change (n = 4). Overall, the proportion of patients assigned to the intermediate-risk category decreased from 56% to 51%.INTERPRETATION: Adding CRP measurement to the diagnostic work-up for suspected pneumonia in primary care improved the discrimination and risk classification of patients. However, it still left a substantial group of patients classified at intermediate risk, in which clinical decision-making remains challenging. |
| Databáze: | OpenAIRE |
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