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Published on: August 7, 2017
Distribution of Nonstandard Inflammatory and Cardiac Biomarker Levels in Children With Fever and Viral or Nonspecific
Danielle N Steinberg1,2, Son H McLaren3, Katherine Aschheim1
1Department of Pediatrics, New York Presbyterian- Columbia, Morgan Stanley Children's Hospital.
Insights
In healthy children with fever, elevated d-dimer, ferritin, and NT-proBNP are common, but troponin elevations are rare. These findings help interpret inflammatory and cardiac biomarker results in pediatric emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pathology
- Infectious Disease Epidemiology
Background:
- Fever in children often prompts evaluation for serious conditions, including multisystem inflammatory syndrome in children (MIS-C).
- Laboratory biomarkers such as d-dimer, ferritin, NT-proBNP, and troponin are often assessed during these evaluations.
- Understanding the distribution of these biomarkers in otherwise healthy children with common febrile illnesses is crucial for accurate diagnosis.
Purpose of the Study:
- To describe the distribution of laboratory values for nonstandard inflammatory and cardiac biomarkers in healthy children presenting with fever and viral or nonspecific illness.
- To establish reference ranges for these biomarkers in a pediatric emergency department (PED) setting for febrile children without severe illness.
Main Methods:
- Retrospective study of 134 children (3 months–20 years) presenting to a PED with fever and evaluated for MIS-C.
- Laboratory values for d-dimer, ferritin, NT-proBNP, and troponin were analyzed.
- Exclusion criteria included comorbidities, MIS-C, Kawasaki disease, myocarditis, or definitive non-viral illness.
Main Results:
- Median values for all biomarkers were within institutional reference ranges, with distributions skewed lower.
- Elevated d-dimer (44%), ferritin (21%), and NT-proBNP (21%) were frequent, while troponin elevations were infrequent (3%).
- No statistically significant differences in biomarker levels were found between non-SARS-CoV-2 viral illness, fever NOS, and SARS-CoV-2 positive illness categories.
Conclusions:
- Otherwise healthy children with fever and viral/nonspecific illness frequently exhibit elevated d-dimer, ferritin, and NT-proBNP above institutional ranges.
- Troponin elevation is uncommon in this pediatric population.
- These findings aid in the interpretation of biomarker results in febrile children, potentially reducing unnecessary concern for severe cardiac or inflammatory conditions.
Objectives:
To describe the distribution of laboratory values for nonstandard inflammatory and cardiac biomarkers in otherwise healthy children presenting to the pediatric emergency department (PED) with fever and viral or nonspecific illness.
Methods:
Single-center retrospective study of otherwise healthy children 3 months to 20 years presenting to the PED with fever and had a laboratory evaluation for multisystem inflammatory syndrome in children (MIS-C) between April 15, 2020 and January 24, 2022. All patients had NT-pro-b-natriuretic peptide (NT-proBNP) or troponin obtained (as part of an institutional pathway for MIS-C evaluation) during this period. Children with comorbidities, MIS-C, Kawasaki disease, myocarditis, or definitive non-viral illness were excluded. We summarized d-dimer, ferritin, troponin, and NT-proBNP distributions using descriptive statistics. One-way analysis of variance tested for differences among 3 disease categories: non-SARS-CoV-2 viral illness, fever not otherwise specified (NOS), and SARS-CoV-2 infection. Outlier values were identified as three times the interquartile range above the third quartile on box-and-whisker plots.
Results:
Of 134 eligible patients, 50, 65, and 19 were categorized as non-SARS-CoV-2 viral illness, fever NOS, and SARS-CoV-2 positive illness, respectively. Median age was 2 years. Median fever duration was 4 days, with 124/134 (93%) described as well-appearing and 112/134 (84%) discharged home. The median values for all biomarkers were within institutional laboratory reference ranges, with all distributions skewed to lower values, and without statistically significant differences between disease categories ( P > 0.05). D-dimer values were above the institutional reference range in 43/97 (44%), ferritin was above the reference range in 24/114 (21%), NT-proBNP was above the reference range in 26/123 (21%), and troponin levels were outside the range in 4/123 (3%). Thirteen patients had extreme outlier values.
Conclusions:
Otherwise healthy children presenting to the PED with a fever and viral or nonspecific illnesses may frequently have elevated serum d-dimer, ferritin, and NT-proBNP above institutional reference ranges. Troponin elevation was infrequent.
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