Pediatric Emergency Medicine Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Faculty of medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Pediatr. 2024 Apr;183(4):1925-1933. doi: 10.1007/s00431-024-05463-0. Epub 2024 Feb 12.
The use of a single C-reactive protein (CRP) value to differentiate between bacterial and non-bacterial causes is limited. Estimated CRP velocity (eCRPv) has shown promise in enhancing such discrimination in adults. This study aims to investigate the association between eCRPv and bacterial etiologies among pediatric patients with very elevated CRP levels. We conducted a retrospective analysis of patients under 18 years of age who had been admitted to our Pediatric Emergency Department from 2018 to 2020 with a fever and CRP levels ≥ 150 mg/L. Bacterial and non-bacterial etiologies were determined from hospital discharge diagnoses, which were monitored independently by three physicians from the research team. The records of 495 suitable patients (51.2% males, median age 3.2 years) were retrieved of whom 444 (89.7%) were eventually diagnosed with bacterial infections. The mean CRP levels were significantly higher for bacterial etiologies compared with other causes (209.2 ± 59.8 mg/L vs. 185.6 ± 35.8 mg/L, respectively, p < .001), while the mean eCRPv values did not differ significantly (p = .15). In a time course analysis, we found that specifically in patients presenting ≥ 72 h after symptom onset, only a eCRPv1 level > 1.08 mg/L/h was an independent predictor of bacterial infection (aOR = 5.5 [95% CI 1.7-17.8], p = .004). Conclusion: Pediatric patients with very high CRP levels and fever mostly have bacterial infections. eCRPv levels, unlike CRP values alone, can serve as the sole independent predictor of bacterial infection > 72 h from symptom onset, warranting further prospective investigations into CRP kinetics in pediatric patients. What is Known: • The use of a single C-reactive protein (CRP) value to differentiate between bacterial and non-bacterial causes is limited. • Estimated CRP velocity (eCRPv) has shown promise in enhancing such discrimination in adults, but data on CRP kinetics in pediatric patients is sparse. What is New: • eCRPv levels, unlike CRP values alone, can serve as the sole independent predictor of bacterial infection > 72 h from symptom onset in pediatric patients with remarkably elevated CRP levels.
使用单个 C 反应蛋白 (CRP) 值来区分细菌性和非细菌性病因是有限的。估计的 CRP 速度 (eCRPv) 已显示出在增强成人中的这种区分能力方面具有潜力。本研究旨在探讨 CRP 动力学在 CRP 水平显著升高的儿科患者中对细菌病因的鉴别诊断中的作用。我们对 2018 年至 2020 年间因发热且 CRP 水平≥150mg/L 而在我院儿科急诊就诊的 18 岁以下患者进行了回顾性分析。细菌和非细菌性病因是根据出院诊断确定的，这些诊断由研究团队的三位医生独立监测。共检索到 495 例符合条件的患者（51.2%为男性，中位年龄 3.2 岁）的记录，其中 444 例（89.7%）最终被诊断为细菌感染。与其他原因相比，细菌病因的 CRP 水平明显更高（分别为 209.2±59.8mg/L 和 185.6±35.8mg/L，p<0.001），而 eCRPv 值差异无统计学意义（p=0.15）。在时间进程分析中，我们发现，特别是在症状出现后≥72 小时就诊的患者中，仅 eCRPv1 水平>1.08mg/L/h 是细菌感染的独立预测因素（优势比=5.5[95%置信区间 1.7-17.8]，p=0.004）。结论：CRP 水平显著升高且发热的儿科患者大多患有细菌感染。与 CRP 值单独使用不同，eCRPv 水平可以作为症状出现后>72 小时细菌感染的唯一独立预测因素，需要进一步对儿科患者 CRP 动力学进行前瞻性研究。已知内容：• 使用单个 C 反应蛋白 (CRP) 值来区分细菌性和非细菌性病因是有限的。• 估计的 CRP 速度 (eCRPv) 已显示出在增强成人中的这种区分能力方面具有潜力，但 CRP 动力学在儿科患者中的数据很少。新内容：• 在 CRP 水平显著升高的儿科患者中，与 CRP 值单独使用不同，eCRPv 水平可以作为症状出现后>72 小时细菌感染的唯一独立预测因素。
