Inflammatory biomarkers to guide diagnostic and therapeutic decisions in children presenting with fever without apparent source.

A systematic review of literature from 2011 to 2016 was performed, in order to evaluate the diagnostic performance of inflammatory biomarkers in children with fever without apparent source and their usefulness in clinical decision-making. Data source was the Pubmed database. Thirteen studies were included, analysing the following biomarkers: erythrocyte sedimentation rate, white blood count, absolute neutrophil count, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6) and the Lab-score (a combination of CRP, PCT and urine dipstick). Among the available biomarkers, CRP and PCT seem to be the most useful, showing the best performance at a threshold of 20 mg/L for CRP and 0.5 ng/mL for PCT. Lab-score increases diagnostic accuracy and also health-care costs. PCT demonstrated higher specificity levels, particularly in younger children. However, CRP remains the most accessible biomarker and is also available as a validated point-of-care test.