C-reactive protein: An easy marker for early differentiation between leptospirosis and dengue fever in endemic area

Abstract

In tropical regions, leptospirosis and dengue fever (DF) are infectious diseases of epidemiological importance and have overlapping symptomatic features. The objective of this study was to identify the factors associated to diagnosing leptospirosis that differentiate it to DF at the initial hospital evaluation. A multicenter retrospective study was conducted comparing confirmed leptospirosis to DF cases. Clinical/laboratory findings were compiled at hospital admission on Reunion Island between 2018 and 2019. Multivariable logistic regression was used to identify the predictors of leptospirosis. In total, 98 leptospirosis and 673 DF patients were included with a mean age of 47.8 (±17.1) and 48.9 (±23.3) years, respectively. In the multivariate analyses, the main parameters associated with leptospirosis were: i) increased neutrophil counts, ii) C-reactive protein values, iii) the absence of prolonged partial thromboplastin time, and iv) a decrease of platelets. The most discriminating parameter was C-reactive protein (CRP). With a threshold of 50mg/L, CRP taken alone had a sensitivity of 94% and a specificity of 93.5%. The positive and negative likelihood ratios were 14.5 and 0.06, respectively. In the setting of an early presumptive diagnosis, we found that an increased CRP value (>50 mg/L) could help diagnose leptospirosis and aid the decision process for hospital surveillance and/or a potential antibiotic treatment regimen.

Fig 1. Study flowchart and diagnostic methods.

*Retrospective analysis of medical and laboratory charts between 2018 and 2019, †Medical chart analysis of patients arriving at the hospital with febrile illness from 01/01/2019 to 06/30/2019.

Fig 2. Receiver operating characteristic (ROC) curve in the diagnostic prediction of leptospirosis versus dengue fever according to the final model and with the C-reactive protein (CRP) alone.

AUC; area under the curve with 95% confidence interval (95% CI) in parenthesis.