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Likelihood Ratio (LR) in Emergency Medicine


Is CRP useful alone to support the hypotesis of a bacteremia?

Clinical Scenario

It’s a very cold February, but ED is very hot in every sense of the word. 
A 22 y/o student refers stomach pain, chills, fever and diffuse muscolar pain. He has fever (38° C) there is a mild diffuse abdominal pain. 
The CRP value is 30 mg/L. 
Are there flu symptoms, or it is a bacteremia?

Can we use the CRP test for change our clinical suspicion? 


CRP is the most used biomarker of infections. 
News under the sun? No!
We can’t consider alone a normal CRP like a marker for rule out a bacteriaemia. At the same time an elevated CRP is not useful alone to prescribe antibiotic therapy. 


NG Adams
Diagnostic use of C-reactive protein in bacteraemic emergency department patients.
Emerg Med Austral 2005 17, 371-5.

JL Vincent
Biomarkers in the critically ill patient: C-reactive protein.
Crit Care Clin  2011 27  241-251

Usefulness of C-Reactive Protein for evaluating clinical outcomes in cirrhotic patients with bacteremia.
Kor J Intern Med june 2011 26 (2) 195-200

Ciro Paolillo