期刊
BRITISH JOURNAL OF GENERAL PRACTICE
卷 69, 期 684, 页码 E462-E469出版社
ROYAL COLL GENERAL PRACTITIONERS
DOI: 10.3399/bjgp19X704309
关键词
blood plasma; blood tests; c-reactive protein; erythrocyte sedimentation rate; primary care
资金
- National Institute for Health Research (NIHR) [DRF-2016-09-034]
- Cancer Research UK [C8640/A23385]
- NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospital Bristol NHS Foundation Trust
- National Institutes of Health Research (NIHR) [DRF-2016-09-034] Funding Source: National Institutes of Health Research (NIHR)
- MRC [MR/M014533/1] Funding Source: UKRI
Background Research comparing C-reactive protein (CRP). erythrocyte sedimentation rate (ESR), and plasma viscosity (PV) in primary care is lacking. Clinicians often test multiple inflammatory markers, leading to concerns about overuse. Aim To compare the diagnostic accuracies of CRP, ESR, and PV, and to evaluate whether measuring two inflammatory markers increases accuracy. Design and setting Prospective cohort study in UK primary care using the Clinical Practice Research Datalink. Method The authors compared diagnostic test performance of inflammatory markers, singly and paired, for relevant disease, defined as any infections, autoimmune conditions, or cancers. For each of the three tests (CRP, FSR, and PV), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operator curve (AUC) were calculated. Results Participants comprised 136 961 patients with inflammatory marker testing in 2014; 83 761 (61.2%) had a single inflammatory marker at the index date, and 53 200 (38.8%) had multiple inflammatory markers. For 'any relevant disease', small differences were seen between the three tests; AUC ranged hum 0.659 to 0.682. CRP had the highest overall AUC, largely because of marginally superior performance in infection (AUC CRP 0.617, versus ESR 0.589, P<0.001). Adding a second test gave limited improvement in the AUC for relevant disease (CRP 0.682, versus CRP plus ESR 0.688, P<0.001); this is of debatable clinical significance. The NPV for any single inflammatory marker was 94% compared with 94.1% for multiple negative tests. Conclusion Testing multiple inflammatory markers simultaneously does not increase ability to rule out disease and should generally be avoided. CRP has marginally superior diagnostic accuracy for infections, and is equivalent for autoimmune conditions and cancers, so should generally be the first-line test.
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