ASSOCIATION BETWEEN C-REACTIVE PROTEIN (CRP) AND CELLULITIS IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Cellulitis can be due to a variety of organisms, including Streptococcus and Staphylococcus species and presents itself as warm, red, swollen, and painful skin with the formation of pus. It commonly manifests in the ED, and differentiating IBD from DVT, contact dermatitis or Venous stasis dermatitis is sometimes challenging. There’s increased level of C- Reactive Protein (CRP), which is a liver protein that is manufactured during inflammation in conditions like infection, autoimmune disease and after trauma. Despite the association of CRP with cellulitis severity, there is limited literature on the diagnostic and prognostic potential of CRP in ED practice.

Objectives: This present research aims at assessing the correlation between the baseline CRP with the severity of cellulitis and to assess the applicability in clinical practice of this biomarker.

Methodology: This cross-sectional work-based study included 200 adult patients with cellulitis attending the ED of a tertiary care facility over a six-month period from February 2016 to July 2016. Serum CRP levels were determined before the onset of treatment at the 99th percentile with the high-sensitivity CRP assays, and the patients were divided into three groups: mild cellulitis, moderate cellulitis, severe cellulitis.

Results: These revealed CRP levels somewhat positively associated with cellulitis severity, r= 0.78, p < 0.001. Mild cellulitis cases had a median CRP of 15 mg/L (IQR: A normal/drinker situation was estimated to be 10–20 mg/L, moderate drinkers were 50 mg/L (IQR: 35–70 mg/L), and heavy drinkers 120 mg/L (IQR: 90–150 mg/L). The hospitalization rates are presented in figure 4 in comparison to CRP levels, reaching 0% in patients with CRP <20 mg/L and 90% in patients with CRP > 100 mg/L.Hospital complicated events such as abscess formation and sepsis occurred only in the setting of CRP > 100 mg/L.

Conclusion: The results corroborate the applicability of CRP in risk-stratifying cellulitis and forecasting complications as well as directing early management. Increased CRP levels relate with inflammation, hospitalization and adverse outcome. Consequently, the integration of CRP into clinical workflows can supplement patient care by alerting clinicians to cases that should be aggressive treat with a probability of recurrence.

Future works: The next research steps must consider serial CRP measurements for a comprehensive evaluation of this marker as well should correlate exact indicators such as procalcitonin. Implementation of CRP integration into EDs has the possibility of improving resource utilization and providing enhanced patients care.