{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:39:36Z","timestamp":1792276776365,"version":"4.4.0"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,9]]},"abstract":"\n \n Object<\/jats:italic>\n <\/jats:title>\n Shunt infections and their management remain a clinically important problem in patients with hydrocephalus. The authors evaluated, in comparison with traditional parameters, C-reactive protein (CRP) in blood\/serum (S-CRP) and in cerebrospinal fluid (CSF; C-CRP) for its power to identify and treat patients with infected shunts.<\/jats:p>\n <\/jats:sec>\n \n \n Methods<\/jats:italic>\n <\/jats:title>\n On 84 different occasions, CSF and blood samples from 59 children suspected of having shunt\/CSF infections were obtained and evaluated. An infection was proven by a CSF culture in 35 of 84 evaluations. Values for S-CRP in infected individuals were higher than in noninfected ones (91.8 \u00b1 70.2 mg\/L compared with 16.1 \u00b1 28.3 mg\/L, p < 0.0001). The sensitivity of S-CRP testing was 97.1%, the specificity 73.5%, the negative predictive value 97.3%, and the receiver operating characteristic area 91.6%. The probability of shunt\/CSF infection\u2014provided that the S-CRP level was greater than 7 mg\/L\u2014rose from 41.7% (prevalence) to a posttest level of 72.3%. Specificity and posttest probability were 87.8 and 87.2%, respectively, if cases with other concurrent infections were excluded. The probability of missing a CSF\/shunt infection at an S-CRP lower than 7 mg\/L was 2.7%. All other diagnostic parameters did not yield useful test results. The rate of reinfection was elevated in patients in whom S-CRP levels were greater than 7 mg\/L at the time of shunt reimplantation.<\/jats:p>\n <\/jats:sec>\n \n \n Conclusions<\/jats:italic>\n <\/jats:title>\n Analysis of these data suggests that the S-CRP level should be included in the first-line workup of patients with suspected shunt\/CSF infection. It seems justified to avoid performing a shunt tap if S-CRP levels are less than 7 mg\/L. A larger multicenter trial is necessary to confirm these promising diagnostic results and to deliver hard data concerning whether or not a normalized S-CRP level is a reliable indicator of successful antibiotic therapy and whether a shunt can be safely reimplanted.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/ped.2005.103.3.0223","type":"journal-article","created":{"date-parts":[[2010,8,27]],"date-time":"2010-08-27T06:01:35Z","timestamp":1282888895000},"page":"223-230","source":"Crossref","is-referenced-by-count":9,"title":["The value of C-reactive protein in the management of shunt infections"],"prefix":"10.3171","volume":"103","author":[{"given":"Martin U.","family":"Schuhmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly R.","family":"Ostrowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily J.","family":"Draper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jau-Wen","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Ham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Sood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"McAllister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Infect Dis","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1093\/infdis\/151.5.854","article-title":"The use of C-reactive protein from cerebrospinal fluid for differentiating meningitis from other central nervous system diseases.","volume":"151","author":"Abramson","year":"1985"},{"key":"b2","series-title":"Indian Pediatr","first-page":"1167","article-title":"C-reactive protein in CNS Infection.","volume":"28","author":"Ahmad","year":"1991"},{"key":"b3","series-title":"Am J Med","doi-asserted-by":"publisher","first-page":"16S","DOI":"10.1016\/S0002-9343(97)89542-3","article-title":"Selection and use of laboratory tests in the rheumatic diseases.","volume":"100","author":"Barland","year":"1996"},{"key":"b4","series-title":"Arch Dis Child","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1136\/adc.54.7.545","article-title":"Serum C-reactive protein test in diagnosis of septic complications of cerebrospinal fluid shunts for hydrocephalus.","volume":"54","author":"Bayston","year":"1979"},{"key":"b5","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1007\/s00701-003-0083-5","article-title":"C-reactive protein levels following standard neurosurgical procedures.","volume":"145","author":"Bengzon","year":"2003"},{"key":"b6","series-title":"An Esp Pediatr","first-page":"47","article-title":"[C-reactive protein. Value in diagnosis of infectious complications of hydrocephalus children with shunt (author's transl).]","volume":"16","author":"Castro-Gago","year":"1982"},{"key":"b7","series-title":"DMC University Laboratories Technology Update 0090\u201403","first-page":"1","article-title":"High-sensitivity C-reactive protein (HS-CRP) - an early predictor of cardiovascular events.","author":"Chu","year":"2003"},{"key":"b8","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1016\/S0022-3476(81)80319-8","article-title":"C-reactive protein in spinal fluid of children with meningitis.","volume":"99","author":"Corrall","year":"1981"},{"key":"b9","series-title":"Cleve Clin J Med","doi-asserted-by":"publisher","first-page":"126","DOI":"10.3949\/ccjm.56.2.126","article-title":"C-reactive protein: the best laboratory indicator available for monitoring disease activity.","volume":"56","author":"Deodhar","year":"1989"},{"key":"b10","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1161\/01.STR.0000065101.20626.FE","article-title":"C-reactive protein and blood pressure in the acute phase after an ischemic stroke.","volume":"34","author":"Di Napoli","year":"2003"},{"key":"b11","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1542\/peds.37.2.270","article-title":"Serum C-reactive protein in infections during the first six months of life.","volume":"37","author":"Felix","year":"1966"},{"key":"b12","series-title":"Ann Thorac Surg","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/S0003-4975(98)00973-4","article-title":"Enhanced preoperative C-reactive protein plasma levels as a risk factor for postoperative infections after cardiac surgery.","volume":"67","author":"Fransen","year":"1999"},{"key":"b13","series-title":"Scand J Clin Lab Invest","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1080\/00365519850186364","article-title":"C-reactive protein and bacterial meningitis: a meta-analysis.","volume":"58","author":"Gerdes","year":"1998"},{"key":"b14","series-title":"Scand J Infect Dis","doi-asserted-by":"publisher","first-page":"625","DOI":"10.3109\/00365549309008552","article-title":"Serum C-reactive protein in the differential diagnosis of acute meningitis.","volume":"25","author":"Hansson","year":"1993"},{"key":"b15","series-title":"Clinical Chemistry: Laboratory Management and Clinical Correlations.","first-page":"531","article-title":"The plasma proteins","author":"Kratz","year":"2002"},{"key":"b16","series-title":"J Microbiol Immunol Infect","first-page":"47","article-title":"Early diagnosis of ventriculoperitoneal shunt infections and malfunctions in children with hydroceohalus.","volume":"36","author":"Lan","year":"2003"},{"key":"b17","series-title":"Eur J Clin Microbiol Infect Dis","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1007\/BF01962340","article-title":"Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: a study in 710 patients with suspected central nervous system infection.","volume":"7","author":"Lindquist","year":"1988"},{"key":"b18","series-title":"Presse Med","first-page":"665","article-title":"[C-reactive protein of the cerebrospinal fluid in children. 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A new evaluation of its diagnostic value.]","volume":"13","author":"Marchand","year":"1984"},{"key":"b19","series-title":"Clinical Chemistry","first-page":"237","author":"Marshall","year":"2000"},{"key":"b20","series-title":"Curr Clin Top Infect Dis","first-page":"155","article-title":"The potential roles of C-reactive protein and procalcitonin concentrations in the serum and cerebrospinal fluid in the diagnosis of bacterial meningitis.","volume":"22","author":"Nathan","year":"2002"},{"key":"b21","series-title":"Acta Paediatr","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1111\/j.1651-2227.2001.tb02421.x","article-title":"Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures.","volume":"90","author":"Oostenbrink","year":"2001"},{"key":"b22","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1542\/peds.92.3.431","article-title":"Significance of serial C-reactive protein responses in neonatal infection and other disorders.","volume":"92","author":"Pourcyrous","year":"1993"},{"key":"b23","series-title":"Clin Chem","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1093\/clinchem\/48.3.591","article-title":"C-reactive protein concentrations in cerebral spinal fluid in gram-positive and gram-negative bacterial meningitis.","volume":"48","author":"Rajs","year":"2002"},{"key":"b24","series-title":"Acta Paediatr Scand","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1111\/j.1651-2227.1974.tb04814.x","article-title":"The clinical usefulness of C-reactive protein (CRP) determinations in bacterial meningitis and septicemia in infancy.","volume":"63","author":"Sabel","year":"1974"},{"key":"b25","series-title":"Scand J Clin Lab Invest","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1080\/003655101753218337","article-title":"Levels of three inflammation markers, C-reactive protein, serum amyloid A protein and procalcitonin, in the serum and cerebrospinal fluid of patients with meningitis.","volume":"61","author":"Shimetani","year":"2001"},{"key":"b26","series-title":"J Neurol Sci","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/0022-510X(84)90157-6","article-title":"C-reactive protein in serum and cerebrospinal fluid in various neurological disorders. 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