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Clinical implications of extremely elevated C-reactive protein among febrile immunocompetent children

Shirley Saar1,2, Oded Scheuerman1,2, Tarek Zuabi1,2

  • 1Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.

Acta Paediatrica (Oslo, Norway : 1992)
|December 16, 2023
PubMed

Insights

Extremely elevated C-reactive protein (CRP) in children often indicates serious bacterial infections like pneumonia or sepsis. These children require prompt medical attention due to increased illness severity and potential intensive care unit admission.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Clinical Chemistry

Background:

  • Elevated C-reactive protein (CRP) is a common biomarker for inflammation in children.
  • Distinguishing the causes and implications of extremely high CRP levels (>30 mg/dL) is crucial for effective clinical management.

Purpose of the Study:

  • To identify diagnoses associated with extremely elevated CRP (>30 mg/dL) in immunocompetent children.
  • To evaluate the clinical implications of extremely elevated CRP during emergency department workup and hospital management.

Main Methods:

  • Retrospective analysis of febrile children (3 months-18 years) in the emergency department.
  • Comparison of children with extremely elevated CRP (>30 mg/dL) versus highly elevated CRP (15-30 mg/dL).

Main Results:

  • Bacterial infections were more prevalent in the extremely elevated CRP group (94.1%) compared to the highly elevated CRP group (78.5%).
  • Bacterial pneumonia, cellulitis, and sepsis were significantly more common in the extremely elevated CRP group.
  • Patients with extremely elevated CRP appeared more ill, received more fluids, and had higher intensive care unit admission rates.

Conclusions:

  • Extremely elevated CRP in febrile children signifies greater illness severity, including hemodynamic instability and need for PICU admission.
  • Bacterial pneumonia is a frequent diagnosis in children with extremely elevated CRP, underscoring the need for thorough investigation.
Abstract

Keywords:
CRPbacterial infectionfeverpaediatrics

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