Isa Hasan M, Mohroofi Abdulrahman D, Alkhan Fatema N, Hasan Asma Z, Alkubisi Mariam M, Alhewaizem Sana S, Khalifa Sara I, Alromaihi Noora G
Consultant Pediatric Gastroenterologist, Pediatric Department, Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain.
Senior House Officer, Pediatric Department, King Hamad University Hospital, Muharraq, Bahrain.
Int J Pediatr. 2022 May 23;2022:1311936. doi: 10.1155/2022/1311936. eCollection 2022.
Of 287 patients, 229 (79.2%) were included. 132 (57.6%) were males. Median presentation age was 3.7 (interquartile range (IQR), 1.27-12.33) months. Median CRP level was 10.4 (IQR, 2.8-35.1) mg/L. CRP was high in 167 (72.9%) patients. 17.6% (33/187 patients) had confirmed bacterial coinfection. Respiratory syncytial virus (RSV) was detected in 84 (36.7%) patients. Mean CRP level was higher in RSV-negative compared to RSV-positive patients, 31.3 ± 44.3 versus 21.5 ± 27.7 mg/L, respectively ( = 0.042). Respiratory viral serology profile was positive in 34.7% (17/49 patients). 66.9% (107/160 patients) had positive chest X-ray. Antibiotics were used in 78.1% (179/227 patients). Thirteen (5.7%) patients required intensive care, five (2.2%) had surgical intervention, four (1.8%) required endotracheal intubation, and four (1.8%) died. Patients with high CRP were older at presentation ( < 0.0001) and had more fever ( < 0.0001) and cough ( = 0.002), but lower hemoglobin level ( < 0.0001) compared to those with normal CRP. Fever ( = 0.016) and hemoglobin level ( = 0.002) were independent factors.
Most children with acute bronchiolitis had high rate of elevated CRP values that did not correlate with the rate of bacterial coinfection. High CRP levels were found in older children, those presented with more fever and cough, and had a lower hemoglobin level despite that those factors were previously reported to be associated with disease severity and bacterial coinfection. This study also showed a high overall rate of antibiotic prescriptions in mostly viral disease.
287例患者中，229例（79.2%）被纳入研究。其中男性132例（57.6%）。发病年龄中位数为3.7个月（四分位间距（IQR）为1.27 - 12.33个月）。CRP水平中位数为10.4mg/L（IQR为2.8 - 35.1mg/L）。167例（72.9%）患者CRP水平较高。17.6%（33/187例患者）确诊有细菌合并感染。84例（36.7%）患者检测到呼吸道合胞病毒（RSV）。RSV阴性患者的平均CRP水平高于RSV阳性患者，分别为31.3±44.3mg/L和21.5±27.7mg/L（P = 0.042）。34.7%（17/49例患者）呼吸道病毒血清学检查呈阳性。66.9%（107/160例患者）胸部X线检查呈阳性。78.1%（179/227例患者）使用了抗生素。13例（5.7%）患者需要重症监护，5例（2.2%）接受了手术干预，4例（1.8%）需要气管插管，4例（死亡率1.8%）死亡。与CRP正常的患者相比，CRP水平高的患者发病时年龄更大（P < 0.0001），发热更多（P < 0.0001），咳嗽更多（P = 0.002），但血红蛋白水平更低（P < 0.0001）。发热（P = 0.016）和血红蛋白水平（P = 0.002）是独立因素。
大多数急性细支气管炎患儿CRP升高率较高，且与细菌合并感染率无关。CRP水平高见于年龄较大的儿童、发热和咳嗽更多的儿童，尽管这些因素先前被报道与疾病严重程度和细菌合并感染有关，但这些患儿血红蛋白水平较低。本研究还显示，在主要为病毒性疾病的情况下，抗生素处方的总体比例较高。
