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. 2025 Jun;53(3):1199-1203.
doi: 10.1007/s15010-024-02422-7. Epub 2024 Oct 28.

Characterizing CRP dynamics during acute infections

Stacey S Cherny #  1   2 , Rafael Y Brzezinski #  3   4 , Asaf Wasserman  3   4 , Amos Adler  3   4 , Shlomo Berliner  3   4 , Daniel Nevo  5 , Saharon Rosset  5 , Uri Obolski  6   7
Affiliations

Characterizing CRP dynamics during acute infections

Stacey S Cherny et al. Infection. 2025 Jun.

Abstract

Purpose: C-reactive protein (CRP) is a common proxy of inflammation, but accurate characterizations of its dynamics during acute infections are scant. The goal of this study was to examine C-reactive protein (CRP) trajectories in hospitalized patients with viral infections, confirmed bacteremia (stratified by Gram-negative or Gram-positive bacteria), and non-bacteremic infections/inflammations, considering antibiotic treatment.

Methods: Electronic medical records from Tel Aviv Sourasky Medical Center (July 2007-May 2023) were analyzed. Patients with blood cultures or positive viral tests were included. CRP levels were modeled using generalized additive mixed-effects models (GAMMs) and observed up to 150 h after initial infection diagnosis. Patients with initial CRP levels > 31.9 were excluded, to remove individuals already in a highly active inflammatory process. The shapes of the CRP curves were characterized and peak CRP as well as area under the CRP curve were the primary variables of interest.

Results: Viral infections had the lowest and flattest CRP curves. Non-bacteremic infections showed intermediate levels, while bacteremia (especially Gram-negative under antibiotic treatment) had the highest CRP peaks. For instance, peak CRP ranged from 15.4 mg/L in viral infections without antibiotics to 140.9 mg/L in Gram-negative bacteremia with antibiotics.

Conclusions: CRP trajectories significantly differ based on infection type and antibiotic treatment. Frequent CRP measurement could be a valuable diagnostic and risk stratification tool in hospitalized patients.

Keywords: Antibiotics; Bacteremia; CRP dynamics; CRP trajectories; Infection.

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Conflict of interest statement

Declarations. Ethical approval: The study was approved by the Institutional Review Board (Helsinki) Committee of Tel Aviv Sourasky Medical Center. Consent to participate: Since this was a retrospective study, using archived medical records, an exemption from informed consent to participate was granted by the Helsinki Committee. Consent to publish: Since this was a retrospective study, using archived medical records, an exemption from consent to publish was granted by the Helsinki Committee. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Estimated trajectory of CRP, stratified by exposure to antibiotics at up to 24 h before or after time zero (AB + vs. AB-), in four cohorts. The vertical axes represent CRP in mg/L, whereas the horizontal axis is the hours from time zero, which is the time of bacterial culture (a, c, d) or viral infection test (b). (a) Patients who tested negative for a viral infection and negative for bacteremia. (b) Patients who tested positive for a viral infection and negative for bacteremia. (c) Patients who tested positive only for a Gram-negative bacteremia. (d) Patients who tested positive only for a Gram-positive bacteremia. CRP trajectories were estimated via generalized additive models, and plotted while accounting for a parametric term for antibiotic use. The models were also adjusted for patients’ age, sex and Charlston comorbidity index. Bands around the curves represent 95% confidence intervals
See this image and copyright information in PMC

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