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. 2022 Dec 7;17(12):e0277401.
doi: 10.1371/journal.pone.0277401. eCollection 2022.

Differentiating between bacterial and viral infections by estimated CRP velocity

Michal Largman-Chalamish  1 , Asaf Wasserman  1 , Adi Silberman  2 , Tal Levinson  3 , Omri Ritter  4   5 , Shlomo Berliner  1 , David Zeltser  1 , Itzhak Shapira  1 , Ori Rogowski  1 , Shani Shenhar-Tsarfaty  1
Affiliations

Differentiating between bacterial and viral infections by estimated CRP velocity

Michal Largman-Chalamish et al. PLoS One. .

Abstract

Purpose: Differentiating between acute viral and bacterial infection is challenging due to the similarity in symptom presentation. Blood tests can assist in the diagnosis, but they reflect the immediate status and fail to consider the dynamics of an inflammatory response with time since symptom onset. We applied estimated C-reactive protein (CRP) velocity (eCRPv), as derived from the admission CRP level divided by time from symptom onset, in order to better distinguish between viral and bacterial infections.

Methods: This cross-sectional study included patients admitted to the emergency department with a confirmed viral (n = 83) or bacterial (n = 181) infection. eCRPv was defined as the ratio between the absolute CRP level upon admission to time from symptom onset (in hours). Absolute CRP and eCRPv values were compared between the 3 groups.

Results: Bacterial patients presented with higher CRP levels (133 mg/L) upon admission compared to viral patients (23.31 mg/L) (P < 0.001). Their median value of eCRPv velocity was 4 times higher compared to the viral patients (1.1 mg/L/h compared 0.25 mg/L/h, P < 0.001). Moreover, in intermediate values of CRP (100-150 mg/L) upon admission, in which the differential diagnosis is controversial, high eCRPv is indicative of bacterial infection, eCRPv >4 mg/L/h represents only bacterial patients.

Conclusions: During an acute febrile illness, the eCRPv value can be used for rapid differentiation between bacterial and viral infection, especially in patients with high CRP values. This capability can potentially expedite the provision of appropriate therapeutic management. Further research and validation may open new applications of the kinetics of inflammation for rapid diagnosis of an infectious vs. a viral source of fever.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of CRP (A) and eCRPv (B) according to source of infection.
Patients with bacterial infections presented with higher CRP levels upon ED admission and higher eCRPV levels compared to patients with viral infections.
Fig 2
Fig 2. Correlation between absolute CRP concentrations and CRP velocity.
Patients with bacterial infections presented with higher correlations between admission CRP (mg/L) and eCRPv (mg/L/h) compared to patients with viral infections. The triangles indicate patients with a bacterial infection and the circles indicate patients with a viral infection.
Fig 3
Fig 3. The ratio between bacterial (blue) and viral (orange color) infections in each range of CRP values.
Fig 4
Fig 4. The ratio between bacterial (blue) and viral (orange color) infections in each range of eCRPv values.
Fig 5
Fig 5. eCRPv values for the groups of patients with iso-CRP levels.
Higher eCRPv values were observed almost exclusively among patients with CRP levels >150 mg/L who had validated bacterial infections.
See this image and copyright information in PMC

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