{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:34:41Z","timestamp":1777613681826,"version":"3.51.4"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2006,4,24]],"date-time":"2006-04-24T00:00:00Z","timestamp":1145836800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2006,4,24]],"date-time":"2006-04-24T00:00:00Z","timestamp":1145836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>Manifestations of sepsis are sensitive but are poorly specific of infection. Our aim was to assess the value of daily measurements of C-reactive protein (CRP), temperature and white cell count (WCC) in the early identification of intensive care unit (ICU)-acquired infections.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>We undertook a prospective observational cohort study (14 month). All patients admitted for \u226572 hours (<jats:italic>n<\/jats:italic> = 181) were divided into an infected (<jats:italic>n<\/jats:italic> = 35) and a noninfected group (<jats:italic>n<\/jats:italic> = 28). Infected patients had a documented ICU-acquired infection and were not receiving antibiotics for at least 5 days before diagnosis. Noninfected patients never received antibiotics and were discharged alive. The progression of CRP, temperature and WCC from day -5 to day 0 (day of infection diagnosis or of ICU discharge) was analyzed. Patients were divided into four patterns of CRP course according to a cutoff value for infection diagnosis of 8.7 mg\/dl: pattern A, day 0 CRP &gt;8.7 mg\/dl and, in the previous days, at least once below the cutoff; pattern B, CRP always &gt;8.7 mg\/dl; pattern C, day 0 CRP \u22648.7 mg\/dl and, in the previous days, at least once above the cutoff; and pattern D, CRP always \u22648.7 mg\/dl.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>CRP and the temperature time-course showed a significant increase in infected patients, whereas in noninfected it remained almost unchanged (<jats:italic>P<\/jats:italic> &lt; 0.001 and <jats:italic>P<\/jats:italic> &lt; 0.001, respectively). The area under the curve for the maximum daily CRP variation in infection prediction was 0.86 (95% confidence interval: 0.752\u20130.933). A maximum daily CRP variation &gt;4.1 mg\/dl was a good marker of infection prediction (sensitivity 92.1%, specificity 71.4%), and in combination with a CRP concentration &gt;8.7 mg\/dl the discriminative power increased even further (sensitivity 92.1%, specificity 82.1%). Infection was diagnosed in 92% and 90% of patients with patterns A and B, respectively, and in only two patients with patterns C and D (<jats:italic>P<\/jats:italic> &lt; 0.001).<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusion<\/jats:title>\n                        <jats:p>Daily CRP monitoring and the recognition of the CRP pattern could be useful in the prediction of ICU-acquired infections. Patients presenting maximum daily CRP variation &gt;4.1 mg\/dl plus a CRP level &gt;8.7 mg\/dl had an 88% risk of infection.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/cc4892","type":"journal-article","created":{"date-parts":[[2006,4,25]],"date-time":"2006-04-25T10:08:01Z","timestamp":1145959681000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":121,"title":["Early identification of intensive care unit-acquired infections with daily monitoring of C-reactive protein: a prospective observational study"],"prefix":"10.1186","volume":"10","author":[{"given":"Pedro","family":"P\u00f3voa","sequence":"first","affiliation":[]},{"given":"Lu\u00eds","family":"Coelho","sequence":"additional","affiliation":[]},{"given":"Eduardo","family":"Almeida","sequence":"additional","affiliation":[]},{"given":"Antero","family":"Fernandes","sequence":"additional","affiliation":[]},{"given":"Rui","family":"Mealha","sequence":"additional","affiliation":[]},{"given":"Pedro","family":"Moreira","sequence":"additional","affiliation":[]},{"given":"Henrique","family":"Sabino","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2006,4,24]]},"reference":[{"key":"4415_CR1","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1056\/NEJMoa022139","volume":"348","author":"GS Martin","year":"2003","unstructured":"Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000.\n                           N Engl J Med 2003, 348: 1546-1554. 10.1056\/NEJMoa022139","journal-title":"N Engl J Med"},{"key":"4415_CR2","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1097\/00003246-200107000-00002","volume":"29","author":"DC Angus","year":"2001","unstructured":"Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.\n                           Crit Care Med 2001, 29: 1303-1310. 10.1097\/00003246-200107000-00002","journal-title":"Crit Care Med"},{"key":"4415_CR3","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1001\/jama.1995.03530120060042","volume":"274","author":"C Brun-Buisson","year":"1995","unstructured":"Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B: Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. 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