C-reactive protein and total leukocyte count as a marker for the screening of early sepsis

► Click here to download the original poster (PDF)

Gaurav Chhabra¹, Raghavendra L¹, Vikas Gaur¹, Amrita Soni², Shubham Rastogi², Kensuke Saito², Takahiro Takeuchi², Sarman Singh¹
¹Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India and ²HORIBA India Pvt Ltd.

Introduction

Antibiotic Resistance is a major healthcare problem worldwide.
Blind therapy is considered to be the most common reason for antibiotic resistance.
Unavailability of lab results before prescription and triage.

Need for study

Source: WHO

Aim and objectives

The aim of the study was to evaluate the usefulness of C-reactive protein and total leukocyte count alone or coupled together as early diagnostic markers of bacterial infections among hospitalised patients.

Material and methods

Five hundred and twenty one patients presenting with signs and symptoms of any local infection or sepsis were included in the study.
Patients on any antibiotic therapy were excluded from the study.
Samples were collected from all the patients for various investigations: Complete hemogram, ESR, C-reactive protein and for culture sensitivity examination.
All patients underwent detailed evaluation and following the reports of the culture examinations the patients were divided into two groups as culture positive and culture negative.

Statistical analysis

Data presentation:

Continuous variable: Mean± SD
Categorical variable: Frequency and percentage

Data analysis:

Comparison between groups
Categorical variable: Chi-square test/ Fischer-exact test
Continuous variable: Student t test/ Wilcoxon rank-sum test

ROC curve analysis

To determine the diagnostic utility of test for diagnosis of infections

Results

Figure 1: Study population

Table 1: Demographic parameters of the study population

Parameter	Culture Positive (n = 87)	Culture Negative (n = 434)	P value
Age*	38.3±18.09	34.8±13.06	0.96
Sex†	Males: 54 (62) Females: 33 (38)	Males: 318 (73) Females: 116 (27)	0.48

Values expressed as * mean ± SD and † n (%)

Figure 2: Hematologic parameters among the two groups

Parameter	Culture Positive (n = 87)	Culture Negative (n = 434)	P value
Hb	9.6±2.3	11.2±3.2	0.03
MCV	82.9±11.57	90.7±17.5	0.001
MCH	28.7±6.6	31.5±7.0	0.0002
MCHC	34.01±1.66	34.25±3.88	0.56
RBC	3.55±0.98	3.71±0.57	0.24
Platelet	327.5±187	199±99.8	< 0.001

Values expressed as mean± SD

Table 3: CRP and leucoyte count among the study population

Parameter	Culture Positive	Culture Negative	P value
TLC	22.6 (4.6-74.2)	6.2 (1.2-42.0)	< 0.001
CRP	17.6 (4.1-74.1)	1.3 (0.2-40)	<0.001
Platelet	296 (11-899)	192 (20-560)	<0.001
Granulocytes	78 (54- 92)	62 (36-81)	0.03
Lymphocytes	21 (06-42)	46 (16-51)	< 0.001

Values expressed as Median (Min-Max.)

Figure 2: ROC curve for various parameters

Table 4: Area under curve value for various parameters

							WBC
	CRP	WBC	GRA%	LYM%	MON%	PLT	CRP
AUC	0.85	0.95	0.87	0.88	0.72	0.69	0.98

Conclusion

WBC counts and C-reactive protein together constitute a rapid and affordable tool for the diagnosis of bacterial infections before the culture results are available.
Differentiation between bacterial infection and non bacterial infection or inflammatory response could help in judicious use of antibiotic treatment.