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Acute phase proteins as markers of systemic illness in acute diarrhoea
J C Darling1, S M Filteau, J A Kitundu
1Centre for International Child Health, Institute of Child Health, London, UK.
Insights
In Tanzanian children with acute diarrhea, elevated C-reactive protein (CRP) and serum amyloid A (SAA) indicated systemic infection (SI). However, these acute phase proteins (APPs) were not reliable markers for SI in this population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Chemistry
Background:
- Acute diarrhea is a common childhood illness, particularly in resource-limited settings.
- Systemic infection (SI) can complicate acute diarrhea, leading to poorer clinical outcomes.
- Acute phase proteins (APPs) are biomarkers of inflammation, but their utility in diagnosing SI in acute diarrhea requires investigation.
Purpose of the Study:
- To evaluate the diagnostic utility of serum acute phase proteins (APPs) in identifying systemic infection (SI) in Tanzanian children hospitalized with acute diarrhea.
- To compare APP levels between children with and without clinical evidence of SI.
- To assess the clinical outcome of acute diarrhea in relation to the presence of SI.
Main Methods:
- A cohort of 57 Tanzanian children (6-25 months) hospitalized with acute diarrhea was studied.
- Children were categorized based on clinical evidence of systemic infection (SI) or its absence.
- Serum concentrations of C-reactive protein (CRP), serum amyloid A (SAA), and alpha1-acid glycoprotein were measured within 48 hours of admission.
Main Results:
- Mean CRP and SAA levels were significantly higher in children with SI compared to those without.
- Alpha1-acid glycoprotein levels did not differ significantly between the groups.
- High CRP levels (>=30 mg/l) showed high specificity (96%) but low sensitivity (51%) for SI.
- Children with SI experienced worse outcomes, including increased need for intravenous fluids, longer diarrhea duration, and higher mortality.
Conclusions:
- While CRP and SAA levels were elevated in children with systemic infection, they were not found to be consistently useful markers for identifying SI in acute diarrhea in this population.
- Clinical judgment remains crucial for diagnosing SI in children with acute diarrhea.
- Further research may be needed to identify more reliable biomarkers for SI in this context.
Abstract:
Fifty-seven Tanzanian children, 6-25 months, hospitalized with acute diarrhoea were grouped according to whether there was clinical evidence of systemic infection (SI) (n = 35) or not (n = 22). Serum acute phase proteins were measured in samples taken within 48 h of admission. Means for C-reactive protein (CRP) and serum amyloid A (SAA) were significantly higher in children with SI compared to those without (geometric means (95% CI); CRP, mg/l: 22.1 (13.6-35.5) vs. 7.4 (4.4-12.4); SAA, mg/l: 12.2 (6.8-22.1) vs. 4.9 (2.5-9.7)). Levels of alpha1-acid glycoprotein were similar in both groups (1.16 g/l (0.95-1.43) vs. 1.04 (0.83-1.29), respectively). CRP > or =30 mg/l had a positive predictive value of 95%, and specificity of 96% for correctly identifying SI, but a low sensitivity (51%) and negative predictive value (55%). Clinical outcome of diarrhoea was worse in children with SI: more needed intravenous fluids (23% vs. 5%), the duration of diarrhoea was longer (59.4 vs. 34.2 h) and mortality was higher (6% vs. 0%). APPs were not found to be useful markers of systemic illness in acute diarrhoea in this population.