TEST-PERFORMANCE OF ERYTHROCYTE SEDIMENTATION-RATE AND C-REACTIVE PROTEIN IN ASSESSING THE SEVERITY OF ACUTE PELVIC INFLAMMATORY DISEASE

OBJECTIVE: The objective of the study was to evaluate the test performance of erythrocyte sedimentation rate and serum C-reactive protein in assessing the severity of acute pelvic inflammatory disease and to determine clinically useful cutoff levels to discriminate mild from severe pelvic inflammatory disease. STUDY DESIGN: The study population consisted of 72 women with acute pelvic inflammatory disease verified by laparoscopy and endometrial histopathologic studies; 37 patients had mild and 35 had severe pelvic inflammatory disease. Cutoff levels for erythrocyte sedimentation rate and C-reactive protein were determined to reach best sensitivity and specificity to discriminate between severe and mild disease. Clinical and microbiologic data were analyzed by chi2, or t test. Logistic regression analysis was used to analyze risk factors for severe pelvic inflammatory disease. RESULTS: Patients with severe pelvic inflammatory disease had higher erythrocyte sedimentation rates and C-reactive protein levels than did those with mild disease. In detecting severe disease an erythrocyte sedimentation rate greater-than-or-equal-to 40 mm/hr and C-reactive protein levels greater-than-or-equal-to 60 mg/L had a sensitivity of 97%, a specificity of 61%, a negative predictive value of 96%, and a positive predictive value of 70%. All patients with tuboovarian abscess or perihepatitis and six of seven patients who had anaerobic bacteria isolated from the fallopian tubes tested positive with these cutoff levels. CONCLUSION: Combined use of erythrocyte sedimentation rate and C-reactive protein levels is useful in assessing the severity of acute pelvic inflammatory disease and augments the clinical decision making regarding treatment.