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Comparative Impact of C-Reactive Protein Testing in Hospitalized Patients with Acute Respiratory Tract Infection: A Retrospective Cohort Study

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Abstract

Introduction

Evidence-based data on the usefulness of C-reactive protein (CRP) monitoring in patient outcomes are lacking. CRP testing in patients with acute respiratory tract infections (ARTIs) showed wide variability between internal medicine wards in our hospital network. In this study we aimed to investigate whether repetitive CRP tests might influence the switch of antibiotic therapy from intravenous (IV) to oral (PO) route and whether CRP measurements affect the combined outcome of readmission and in-hospital mortality.

Methods

This was a retrospective cohort study conducted in two internal medicine wards selected in a network of five teaching hospitals on the basis of their CRP prescription frequency. Clinical and laboratory data of 296 patients with ARTIs and admitted from 1 January to 31 December 2016 were analyzed.

Results

The mean ± SD of CRP tests/patient and the in-hospital length of antibiotic therapy (days) in the low-CRP (L-CRP) vs the high-CRP (H-CRP) wards were 1.14 ± 0.62 vs 3.43 ± 1.54 (p < 0.001) and 7.1 ± 2.6 vs 7.5 ± 3.2 (p = 0.298), respectively. The probability of antibiotic switching was higher in the L-CRP ward (HR 2.90, 95% CI 1.69–4.95, p < 0.001) correlating with the lower number of CRP determinations (HR 1.20, 95% CI 1.01–1.41, p = 0.034). In-hospital readmissions and mortality rates did not significantly differ between the two wards (L-CRP 17.1% vs H-CRP 10.0%, p = 0.133). The number of CRP determinations affected the combined outcome (OR 1.38, 95% CI 1.01–1.90, p = 0.043).

Conclusions

Repetitive CRP testing in ARTIs offers no added value to either antibiotic switch or patient outcomes in hospitalized patients in internal medicine wards.

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Acknowledgments

Funding

No funding or sponsorship was received for this study or publication of this article. The Rapid Service Fee was funded by the authors. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

Olivier Giannini and Rosaria Del Giorno contributed equally to this work.

Disclosures

Olivier Giannini, Rosaria Del Giorno, Anna Zasa and Luca Gabutti declare that they have no conflicts of interest.

Compliance with Ethics Guidelines

The study was conducted in accordance with the Declaration of Helsinki. The study was exempt from institutional review board approval by the Swiss Ethics Committee because it involved anonymous secondary data only. Informed consent was not obtained because the data were from de-identified and previously collected administrative data.

Data Availability

The dataset analyzed during the current study is available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Service of Nephrology, Ente Ospedaliero Cantonale (EOC), Ospedale Regionale della Beata Vergine, Mendrisio, Switzerland

    Olivier Giannini

  2. Department of Internal Medicine and Service of Nephrology, Ente Ospedaliero Cantonale (EOC), Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland

    Rosaria Del Giorno & Luca Gabutti

  3. Quality and Patient Safety Service, Ente Ospedaliero Cantonale (EOC), Ospedale La Carità, Locarno, Switzerland

    Anna Zasa

  4. Institute of Biomedicine, University of Southern Switzerland (USI), Lugano, Switzerland

    Luca Gabutti

Authors
  1. Olivier Giannini
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  2. Rosaria Del Giorno
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  3. Anna Zasa
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  4. Luca Gabutti
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Corresponding author

Correspondence to Rosaria Del Giorno.

Additional information

Olivier Giannini and Rosaria Del Giorno have joint first authorship.

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Giannini, O., Del Giorno, R., Zasa, A. et al. Comparative Impact of C-Reactive Protein Testing in Hospitalized Patients with Acute Respiratory Tract Infection: A Retrospective Cohort Study. Adv Ther 36, 3186–3195 (2019). https://doi.org/10.1007/s12325-019-01090-6

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  • DOI: https://doi.org/10.1007/s12325-019-01090-6

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