CRP under 130 mg/L rules out the diagnosis of Legionella pneumophila serogroup 1 (URINELLA Study)

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2024年3月26日

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Timothée Klopfenstein,
Souheil Zayet,
Samantha Poloni,
Vincent Gendrin,
Damien Fournier,
Jean-Baptiste Vuillemenot,
Philippe Selles,
Alain Dussaucy,
Gaelle Coureau,
Marta Avalos-Fernandez,
Lynda Toko,
Pierre-Yves Royer,
Charles-Eric Lavoignet,
Bouchra Amari,
Marc Puyraveau,
Catherine Chirouze

摘要

Introduction

In case of pneumonia, some biological findings are suggestive for Legionnaire’s disease (LD) including C-reactive protein (CRP). A low level of CRP is predictive for negative Legionella Urinary-Antigen-Test (L-UAT).

Method

Observational retrospective study in Nord-Franche‐Comté Hospital with external validation in Besançon University Hospital, France which included all adults with L-UAT performed during January 2018 to December 2022. The objective was to determine CRP optimal threshold to predict a L-UAT negative result.

Results

URINELLA included 5051 patients (83 with positive L-UAT). CRP optimal threshold was 131.9 mg/L, with a negative predictive value (NPV) at 100%, sensitivity at 100% and specificity at 58.0%. The AUC of the ROC-Curve was at 88.7% (95% CI, 86.3–91.1). External validation in Besançon Hospital patients showed an AUC at 89.8% (95% CI, 85.5–94.1) and NPV, sensitivity and specificity was respectively 99.9%, 97.6% and 59.1% for a CRP threshold at 131.9 mg/L; after exclusion of immunosuppressed patients, index sensitivity and NPV reached also 100%.

Conclusion

In case of pneumonia suspicion with a CRP level under 130 mg/L (independently of the severity) L-UAT is useless in immunocompetent patients with a NPV at 100%. We must remain cautious in patients with symptoms onset less than 48 h before CRP dosage.