Skip to main content
Log in

C-Reactive protein is more sensitive than erythrocyte sedimentation rate for diagnosis of infective endocarditis

  • Originalia
  • Published:
Infection Aims and scope Submit manuscript

Summary

The objective of this study was to evaluate the sensitivity of C-reactive protein (CRP) elevation compared to erythrocyte sedimentation rate (ESR), leucocyte count and thrombocyte count in the diagnosis of infective endocarditis (IE). It was designed as a prospective study of suspected episodes of IE in adults in tertiary care at a university-affiliated department of infectious diseases. In 89 episodes of IE, CRP was available from the start of treatment. Median age was 66 years, 45 were men and 44 women. Median CRP concentration was found to be 90 (range 0–357) mg/l with only 4% normal values. Episodes involving native valves had higher CRP than episodes occurring with prosthetic valves. Staphylococcal origin, short duration of symptoms, short duration of fever and highest recorded temperature all correlated to higher CRP levels. The CRP response was also prominent among patients >70 years old. Among non-responders, a few cases with simultaneous cirrhosis were noted. ESR was less sensitive than CRP, with a normal level in 28% of the episodes. It was concluded that CRP determination is superior to erythrocyte sedimentation rate, leucocyte count and thrombocyte count in the diagnosis of infective endocarditis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. McCartney, A. C., Orange, G. V., Pringle, S. D., Wills, G. Serum C-reactive protein in infective endocarditis. J. Clin. Pathol. 41 (1988) 44–48.

    PubMed  Google Scholar 

  2. Janatuinen, M. J., Vanttinen, E. A., Nikoskelainen, J., Inberg, M. V. Surgical treatment of active native valve endocarditis. Scand. J. Thorac. Cardiovasc. Surg. 24 (1990) 181–185.

    PubMed  Google Scholar 

  3. Chao, C.-H., Liu, C.-Y., Cheng, D.-L., Duh, R.-W., Hu, B.-S. Overview of viridans streptococcal endocarditis: clinical analysis of 99 cases. Chin. Med. J. (Taipei) 48 (1991) 351–358.

    Google Scholar 

  4. Hogevik, H., Olaison, L., Andersson, R., Lindberg, J., Alestig, K. Epidemiological aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine (Baltimore) 74 (1995) 324–339.

    Article  PubMed  Google Scholar 

  5. Olaison, L., Hogevik, H., Mykén, P., Odén, A., Alestig, K. Early surgery in infective endocarditis. Q. J. Med. 89 (1996) 267–278.

    Google Scholar 

  6. Durack, D. T., Lukes, A. S., Bright, D. K. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am. J. Med. 96 (1994) 200–209.

    Article  PubMed  Google Scholar 

  7. Olaison, L., Hogevik, H. Comparison of the von Reyn and Duke criteria for the diagnosis of infective endocarditis. A critical analysis of 161 episodes. Scand. J. Infect. Dis. 28 (1996) 399–406.

    PubMed  Google Scholar 

  8. Benattar, C., Francoual, J., Magny, J. F., Lindenbaum, A. Development of a rapid method of immuno-assay of C-reactive protein by polarisation of fluorescence. Ann. Biol. Clin. 47 (1989) 181–185.

    Google Scholar 

  9. Shine, B., de Beer, F. C., Pepys, M. B. Solid phase radioimmunoassays for C-reactive protein. Clin. Chim. Acta 117 (1981) 13–23.

    Article  PubMed  Google Scholar 

  10. Reyn, C. F. von, Levy, B. S., Arbeit, R. D., Friedland, G., Crumpacker, C. S. Infective endocarditis: an analysis based on strict case definitions. Ann. Intern. Med. 84 (1981) 505–518.

    Google Scholar 

  11. Bradley, J. W. Distribution-free statistical tests. Prentice-Hall, London, 1968, pp. 68–86.

    Google Scholar 

  12. Odén, A., Wedel, H. Arguments for Fisher's permutation test. Annals of Statistics 3 (1975) 518–520.

    Google Scholar 

  13. Mantel, N. Chi-square tests with one degree of freedom; extensions of the Mantel-Haenszel procedure. J. Am. Statistical Assoc. 58 (1963) 690–700.

    Google Scholar 

  14. Kushner, I., Mackiewicz, A. Acute phase proteins as disease markers. Disease Markers 5 (1987) 1–11.

    PubMed  Google Scholar 

  15. Whitby, M., Fenech, A. Infective endocarditis in adults in Glasgow, 1976–81. Int. J. Cardiol. 7 (1985) 391.

    Article  PubMed  Google Scholar 

  16. Julander, I., Svanbom, M. Prediction of staphylococcal etiology among patients with septicemia with or without endocarditis by use of multivariate statistical methods. Scand. J. Infect. Dis. 17 (1985) 37–46.

    PubMed  Google Scholar 

  17. Lindbäck, S., Hellgren, U., Julander, I., Hansson, L.-O. The value of C-reactive protein as a marker of bacterial infection in patients with septicemia/endocarditis and influenza. Scand. J. Infect. Dis. 21 (1989) 543–549.

    PubMed  Google Scholar 

  18. Macintyre, S. S., Schultz, D., Kushner, I. Biosynthesis of C-reactive protein. Ann. NY Acad. Sci. 389 (1982) 76–87.

    PubMed  Google Scholar 

  19. Terpenning, M. S., Buggy, B. P., Kauffman, C. A. Infective endocarditis: clinical findings in young and elderly patients. Am. J. Med. 83 (1987) 626–634.

    Article  PubMed  Google Scholar 

  20. Kenny, R. A., Hodkinson, H. M., Cox, M. L., Caspi, D., Pepys, M. B. Acute phase protein response to infection in elderly patients. Age Ageing 13 (1984) 89–94.

    PubMed  Google Scholar 

  21. Kaye, K. M., Kaye, D. Laboratory findings including blood cultures. In:Kaye, D. (ed.): Infective endocarditis. 2nd ed. Raven Press, New York 1992, pp. 117–124.

    Google Scholar 

  22. Lerner, P. I., Weinstein, L. Infective endocarditis in the antibiotic era. N. Engl. J. Med. 274 (1966) 199–206, 323–331, 388–393.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hogevik, H., Olaison, L., Andersson, R. et al. C-Reactive protein is more sensitive than erythrocyte sedimentation rate for diagnosis of infective endocarditis. Infection 25, 82–85 (1997). https://doi.org/10.1007/BF02113580

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02113580

Keywords

Navigation