(P102) PROGNOSTIC AND DIAGNOSTIC VALUES OF C-REACTIVE PROTEIN AND PROCALCITONIN IN INFECTIVE ENDOCARDITIS: A SYSTEMATIC REVIEW

Background: Infective endocarditis (IE) is an inflammatory disorder affecting the endocardium, particularly the heart valves. Despite decades after being discovered in 1885 by Sir William Osler, mortality and morbidity remain high in IE. Historically many serum inflammatory biomarkers such as white blood count (WBC), platelet counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin (PCT) have been proposed for their utility in the diagnosis of IE and prognostication following an IE infection. Our systematic review aimed to explore the value of easily accessible and contemporary inflammatory biomarkers, PCT and CRP in their role in IE diagnosis and prognosis.

METHODS AND RESULTS: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) updated guide for 2020. Four databases, namely PubMed, Ovid (Embase), Scopus and Cochrane Library, were searched up to April 2024. A total of 51 studies with a total number of 5372 patients were included, meeting the prespecified criteria, including reporting inflammatory markers like CRP and PCT in patients meeting the Duke and Modified Duke criteria for IE diagnosis. Non-English publications were excluded. Studies included native valve IE and prosthetic valve IE. There was marked heterogeneity in the methodology of the identified studies. A specific conclusion could not be drawn with respect to PCT and CRP in assisting with the diagnosis or prognosis. However a positive correlation of elevated PCT and the likelihood of having S.Aureus as a causative agent was present. Overall, no specific differences were noted between native or prosthetic valve IE. Those results may not be easily generalized across IV drug users and those with cardiac implantable devices. Of note, none of those studies were conducted in North America.

Conclusion: The results were mixed with regards to the utility of CRP and PCT in predicting the diagnosis and/or prognosis of IE. Those inconsistent findings may have resulted from different patient populations, methodological approaches, or specific criteria used. As such, the benefit of adding those markers in predictive models of IE is unclear. However, PCT may have a role in the early identification of S. aureus IE, a highly destructive organism with variable sensitivities. Further studies are needed to clarify the role of those markers in predicting the diagnosis and prognosis of IE.