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Published on: December 10, 2013
C-Reactive Protein Is Associated with Severity in Hospitalized Children with Respiratory Syncytial Virus
Assaf Adar1, Aviv D Goldbart2, Nitzan Burrack3
1Department 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.
Insights
Elevated C-reactive protein (CRP) levels in hospitalized infants with respiratory syncytial virus (RSV) bronchiolitis indicate increased disease severity and higher complication risks. This finding aids in predicting outcomes for young children with RSV infections.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Biochemistry
- Respiratory Medicine
Background:
- Acute bronchiolitis, predominantly caused by respiratory syncytial virus (RSV), is a major cause of pediatric hospitalization.
- Current diagnostic practices often rely on clinical assessment, with laboratory evaluations having limited established validity.
- Understanding biomarkers associated with disease severity is crucial for effective management.
Purpose of the Study:
- To investigate the correlation between C-reactive protein (CRP) serum levels upon admission and the severity of illness in children hospitalized with RSV bronchiolitis.
- To identify potential predictive value of CRP for disease complications and resource utilization.
Main Methods:
- Retrospective cohort study design.
- Inclusion of 1874 children aged 0-24 months hospitalized with RSV bronchiolitis between 2018 and 2022.
- Analysis of C-reactive protein (CRP) serum levels measured at the time of hospital admission.
Main Results:
- Children with elevated CRP (> 1.92 mg/dl) were older and exhibited higher incidences of pneumonia, urinary tract infections (UTI), and acute otitis media (AOM).
- Elevated CRP was associated with increased rates of pediatric intensive care unit (PICU) admission, antibiotic treatment, and longer hospital stays.
- Multivariable analysis confirmed CRP as a predictor for UTI, PICU admission, pneumonia, and prolonged hospitalization, with specific CRP thresholds identified for these outcomes.
Conclusions:
- Elevated C-reactive protein (CRP) levels at hospital admission are significantly associated with increased disease severity in pediatric RSV bronchiolitis.
- Higher CRP levels correlate with a greater likelihood of complications such as pneumonia, UTI, and AOM.
- CRP serves as a valuable biomarker for predicting adverse outcomes and guiding clinical management in hospitalized children with RSV bronchiolitis.
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.
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