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. 2005 Jul 2;331(7507):26.
doi: 10.1136/bmj.38483.478183.EB. Epub 2005 Jun 24.

Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review

Victor van der Meer  1 , Arie Knuistingh Neven, Peterhans J van den Broek, Willem J J Assendelft
Affiliations

Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review

Victor van der Meer et al. BMJ. .

Abstract

Objectives: To evaluate the diagnostic accuracy of C reactive protein in detecting radiologically proved pneumonia and to evaluate how well it can discriminate between bacterial and viral infections of the lower respiratory tract.

Data sources: Medline and Embase (January 1966 to April 2004), with reference checking.

Study selection: We included articles comparing C reactive protein with a chest radiograph or with microbiological work-up as a reference test. Two authors independently assessed methodological items.

Results: None of the studies met all validity criteria. Six studies used an infiltrate on chest radiograph as reference test. Sensitivities ranged from 10% to 98%, specificities from 44% to 99%. For adults, the relation of C reactive protein with an infiltrate (in a subgroup analysis of five studies) showed an area under the curve of 0.80 (95% confidence interval 0.75 to 0.85). In 12 studies, the relation of C reactive protein with a bacterial aetiology of infection of the lower respiratory tract was studied. Sensitivities ranged from 8% to 99%, specificities from 27% to 95%. These data were epidemiologically and statistically heterogeneous, so overall outcomes could not be calculated.

Conclusion: Testing for C reactive protein is neither sufficiently sensitive to rule out nor sufficiently specific to rule in an infiltrate on chest radiograph and bacterial aetiology of lower respiratory tract infection. The methodological quality of the diagnostic studies is generally poor. The evidence not consistently and sufficiently supports a wide introduction of C reactive protein as a rapid test to guide antibiotics prescription.

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Figures

Fig 1
Fig 1
Flow of studies through the stages of the review
Fig 2
Fig 2
Sensitivity-specificity plot (with 95% confidence intervals) of C reactive protein in relation to detection of an infiltrate (top) or bacterial aetiology (bottom). Measurements of C reactive protein are presented in ascending order
Fig 3
Fig 3
Summary receiver operating characteristic curve of five studies dealing with the radiological detection of an infiltrate in adults
See this image and copyright information in PMC

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