• Margaretha C Minnaard, de GrootJoris A HJAHUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center f, Rogier M Hopstaken, Alwin Schierenberg, Niek J de Wit, Johannes B Reitsma, BroekhuizenBerna D LBDLUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Cente, Saskia F van Vugt, NevenArie KnuistinghAKUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center, Aleida W Graffelman, Hasse Melbye, Timothy H Rainer, Johann Steurer, Anette Holm, Ralph Gonzales, Geert-Jan Dinant, Alma C van de Pol, and VerheijTheo J MTJMUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for.
• University Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands m.c.minnaard@umcutrecht.nl.
• CMAJ. 2017 Jan 16; 189 (2): E56-E63.

BackgroundC-reactive protein (CRP) is increasingly being included in the diagnostic work-up for community-acquired pneumonia in primary care. Its added diagnostic value beyond signs and symptoms, however, remains unclear. We conducted a meta-analysis of individual patient data to quantify the added value of CRP measurement.MethodsWe included studies of the diagnostic accuracy of CRP in adult outpatients with suspected lower respiratory tract infection. We contacted authors of eligible studies for inclusion of data and for additional data as needed. The value of adding CRP measurement to a basic signs-and-symptoms prediction model was assessed. Outcome measures were improvement in discrimination between patients with and without pneumonia in primary care and improvement in risk classification, both within the individual studies and across studies.ResultsAuthors of 8 eligible studies (n = 5308) provided their data sets. In all of the data sets, discrimination between patients with and without pneumonia improved after CRP measurement was added to the prediction model (extended model), with a mean improvement in the area under the curve of 0.075 (range 0.02-0.18). In a hypothetical cohort of 1000 patients, the proportion of patients without pneumonia correctly classified at low risk increased from 28% to 36% in the extended model, and the proportion with pneumonia correctly classified at high risk increased from 63% to 70%. The number of patients with pneumonia classified at low risk did not change (n = 4). Overall, the proportion of patients assigned to the intermediate-risk category decreased from 56% to 51%.InterpretationAdding CRP measurement to the diagnostic work-up for suspected pneumonia in primary care improved the discrimination and risk classification of patients. However, it still left a substantial group of patients classified at intermediate risk, in which clinical decision-making remains challenging.© 2017 Joule Inc. or its licensors.

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