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. 2018 Dec;51(6):839-846.
doi: 10.1016/j.jmii.2018.08.003. Epub 2018 Aug 23.

C-reactive protein levels can predict positive 18F-FDG PET/CT findings that lead to management changes in patients with bacteremia

Han-Yu Tsai  1 , Ming-Hsun Lee  1 , Chih-Hsing Wan  2 , Lan-Yan Yang  3 , Tzu-Chen Yen  4 , Jing-Ren Tseng  5
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C-reactive protein levels can predict positive 18F-FDG PET/CT findings that lead to management changes in patients with bacteremia

Han-Yu Tsai et al. J Microbiol Immunol Infect. 2018 Dec.
Free article

Abstract

Background/purpose: Bacteremia portends high rates of morbidity and mortality. Although 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) imaging has clinical value in assessing fever of unknown origin, its usefulness in bacteremia has not been entirely elucidated. We therefore designed the current single-center retrospective study to investigate 1) the clinical value of 18F-FDG PET/CT imaging in assessing bacteremia and 2) the association between laboratory data and imaging findings.

Methods: We examined 102 patients with bacteremia who had undergone 18F-FDG PET/CT imaging. The patients' clinical and laboratory data were reviewed and analyzed in relation to 18F-FDG PET/CT findings. Patients showing positive results underwent quantitative measurements of 18F-FDG uptake.

Results: Positive 18F-FDG PET/CT findings were identified in 74 (72.5%) patients, and 40 (54.1%) underwent modified treatment or management because of the imaging results (p = 0.003). Positive 18F-FDG PET/CT findings were significantly associated with higher white blood cell (WBC) counts and C-reactive protein (CRP) levels (p = 0.012 and < 0.001, respectively). Notably, CRP levels accurately predicted (area under curve = 0.752; p < 0.001) positive 18F-FDG PET/CT findings (optimal cut-off point: 54.025 mg/L).

Conclusion: A majority (54.1%, n = 40) of the patients with positive 18F-FDG PET/CT results underwent treatment modifications; they accounted for most cases (87%) of management changes in our cohort. Leukocytosis and increased CRP levels are significantly associated with positive 18F-FDG PET/CT findings in patients with bacteremia. CRP levels >54.025 mg/L were accurate predictors of positive 18F-FDG PET/CT results.

Keywords: (18)F-fluorodeoxyglucose positron emission tomography and computed tomography; Bacteremia; C-reactive protein.

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