C反应蛋白与住院呼吸道合胞病毒细支气管炎患儿的病情严重程度相关。

C-Reactive Protein Is Associated with Severity in Hospitalized Children with Respiratory Syncytial Virus Bronchiolitis.

作者信息

Adar Assaf, Goldbart Aviv D, Burrack Nitzan, Geva Neta, Cohen Bracha, Golan-Tripto Inbal

机构信息

Department of Pediatrics B, Saban Children's Hospital, Soroka University Medical Center, Beer Sheva, Israel, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.

Department of Pediatrics B, Saban Children's Hospital, Soroka University Medical Center, Beer Sheva, Israel, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel, Pediatric Pulmonary Unit, Saban Children's Hospital, Soroka University Medical Center, Beer Sheva, Israel.

出版信息

Isr Med Assoc J. 2025 Mar;27(3):165-171.

PMID:40134169

Abstract

BACKGROUND

Acute bronchiolitis, primarily caused by respiratory syncytial virus (RSV), is the leading cause of hospitalization in young children. Despite international guidelines supporting clinical diagnosis, laboratory evaluations are often conducted with limited validity.

OBJECTIVES

To evaluate the association between C-reactive protein (CRP) serum levels on admission and disease severity in children hospitalized due to RSV bronchiolitis.

METHODS

This retrospective cohort study included children (0-24 months old) who were hospitalized due to RSV bronchiolitis (2018-2022), CRP levels taken at admission.

RESULTS

We included 1874 children (mean age of 6.7 months, 59% males); median CRP level 1.92 mg/dl. Children with elevated CRP (> 1.92 mg/dl) were significantly older (5.1 vs. 3.8 months, P < 0.001) and had higher rates of pneumonia (9.4% vs. 4.3%, P < 0.001), urinary tract infection (UTI), (2.2% vs. 0.2%, P < 0.001), acute otitis media (AOM) (1.7% vs. 0.2%, P < 0.001), admissions to the pediatric intensive care unit (PICU) (7.4% vs. 3.7%, P < 0.001), antibiotic treatment (49.8% vs. 37.2%, P < 0.001), and longer hospitalizations (3.83 vs. 3.31 days, P < 0.001). Multivariable analysis predicted increased risk for UTI, PICU admission, pneumonia, and longer hospitalization (relative risk 11.6, 2.25, 1.98, 1.44, respectively, P < 0.001). CRP thresholds of 3.51, 1.9, and 2.81 mg/dl for PICU admission, UTI, and pneumonia, were calculated using Youden's index with AUC 0.72, 0.62, and 0.61, respectively.

CONCLUSIONS

Elevated CRP levels at admission are associated with increased disease severity and higher complication rates in children hospitalized with RSV bronchiolitis.

摘要

背景

急性细支气管炎主要由呼吸道合胞病毒（RSV）引起，是幼儿住院的主要原因。尽管国际指南支持临床诊断，但实验室评估的有效性往往有限。

目的

评估因RSV细支气管炎住院的儿童入院时血清C反应蛋白（CRP）水平与疾病严重程度之间的关联。

方法

这项回顾性队列研究纳入了因RSV细支气管炎住院的儿童（0 - 24个月）（2018 - 2022年），记录入院时的CRP水平。

结果

我们纳入了1874名儿童（平均年龄6.7个月，59%为男性）；CRP中位数水平为1.92mg/dl。CRP升高（>1.92mg/dl）的儿童年龄显著更大（5.1个月对3.8个月，P<0.001），肺炎发生率更高（9.4%对4.3%，P<0.001），尿路感染（UTI）发生率更高（2.2%对0.2%，P<0.001），急性中耳炎（AOM）发生率更高（1.7%对0.2%，P<0.001），入住儿科重症监护病房（PICU）的比例更高（7.4%对3.7%，P<0.001），接受抗生素治疗的比例更高（49.8%对37.2%，P<0.001），住院时间更长（3.83天对3.31天，P<0.001）。多变量分析预测UTI、入住PICU、肺炎和住院时间延长的风险增加（相对风险分别为11.6、2.25、1.98、1.44，P<0.001）。使用约登指数计算得出，PICU入院、UTI和肺炎的CRP阈值分别为3.51mg/dl、1.9mg/dl和2.81mg/dl，AUC分别为0.72、0.62和0.61。