DIAGNOSTIC AND PROGNOSTIC USEFULNESS OF A CUTE-PHASE PROTEIN ASSAYS IN ELDERLY PATIENTS WITH ERYTHROCYTE SEDIMENTATION-RATES ABOVE 100 MM H/

:The diagnostic and prognostic usefulness of acute phase protein assay s in patients older than 80 years with evidence of severe inflammation was assessed prospectively, Over a ten-month period, 39 subjects with a mean age of 87.3 +/- 4 years admitted to a geriatric department had an erythrocyte sedimentation rate greater than 100 mm/h at admission. Extensive diagnostic investigations and laboratory tests for inflamma tion were done in every case. Mortality was determined over three mont hs. Infection was the most common abnormality (43.6%), followed by acu te articular chondrocalcinosis (18%) and malignancies (13%). Markers f or inflammation were compared in the 17 patients with and in the 22 pa tients without documented infections, Mean serum levels nf haptoglobin and orosomucoid were significantly higher in the group with infection s as compared with the other group. There was no significant differenc e for mean C-reactive protein (CRP) levels, The positive predictive va lue of CRP or the diagnosis of infection was greatest when the cutoff was 100 mg/l. (78%), Comparisons of mean CRP, albumin, and prognostic inflammatory index (PINI) values failed to detect any significant diff erences between subjects who died within three months of admission and survivors. In elderly subjects with an erythrocyte sedimentation rate greater than 100 mm/h, a CRP level above 100 mg/l is highly suggestiv e of a bacterial infection. CRP, albumin, and the PINI had no prognost ic value in this selected population, perhaps because of the frequency of acute articular chondrocalcinosis among the causes of severe infla mmatory syndrome.