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Published on: November 5, 2021
Inflammatory Markers in Pediatric Bacterial Sepsis vs. SARS-CoV-2 Infection: A Retrospective Study
Antonio Andrusca1, Cristina Maria Mihai1, Cosmin Alexandru Pantazi1
1Pediatrics, Faculty of General Medicine, "Ovidius" University of Constanta, Constanta, Romania.
Insights
Differentiating pediatric bacterial sepsis from viral SARS-CoV-2 infection is crucial. Bacterial sepsis shows higher C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), while COVID-19 has elevated fibrinogen and variable D-dimer levels.
Area of Science:
- Pediatric infectious diseases
- Clinical immunology
- Biomarker analysis
Background:
- Early differentiation between bacterial sepsis and viral infections like SARS-CoV-2 in children is critical for effective treatment.
- Inflammatory markers are key indicators, but their profiles may differ between these conditions.
Purpose of the Study:
- To compare inflammatory marker profiles (CRP, fibrinogen, ESR, D-dimer) in pediatric bacterial sepsis versus SARS-CoV-2 infection.
- To identify distinct patterns that aid in early diagnosis.
Main Methods:
- Retrospective analysis of 97 pediatric sepsis cases and 100 pediatric COVID-19 cases.
- Extraction and statistical comparison of initial inflammatory marker levels (CRP, fibrinogen, ESR, D-dimer).
- Significance level set at p<0.05.
Main Results:
- Bacterial sepsis demonstrated significantly higher C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) compared to COVID-19.
- Fibrinogen levels were significantly lower in pediatric sepsis than in COVID-19.
- D-dimer levels were elevated in both groups, with higher variability observed in COVID-19 patients.
Conclusions:
- Distinct inflammatory marker profiles differentiate pediatric bacterial sepsis from COVID-19.
- Bacterial sepsis is associated with a stronger CRP and ESR response.
- COVID-19 is characterized by elevated fibrinogen and more variable D-dimer levels.
Abstract:
Early differentiation between bacterial sepsis and viral infection in pediatric patients is critical for timely and appropriate therapy. We compared the inflammatory markers C-reactive protein (CRP), fibrinogen, erythrocyte sedimentation rate (ESR), and D-dimer in children with bacterial sepsis and those with SARS-CoV-2 infection to discern characteristic profiles.
Methods:
We retrospectively analyzed 97 pediatric sepsis cases (culture-confirmed bacterial infections) and 100 pediatric COVID-19 cases (RT-PCR-confirmed SARS-CoV-2). The initial inflammatory marker levels were extracted from the medical records. Statistical comparisons of means and medians were performed, with significance set at p<0.05.
Results:
CRP levels were markedly higher in bacterial sepsis (mean 8.1mg/dL, median 7.4mg/dL) than in COVID-19 (mean 4.1mg/dL, median 3.35mg/dL; p<0.001). ESR was also elevated in sepsis (mean 46mm/h) versus COVID-19 (mean 26mm/h; p<0.001). Fibrinogen showed the opposite pattern, being significantly lower in sepsis (mean 304.7mg/dL, median 267mg/dL) than in COVID-19 (mean 421mg/dL, median 448mg/dL; p<0.001). D-dimer was high in both groups; the COVID-19 cohort had a higher mean D-dimer (3.2μg/mL) with considerable variability, whereas the sepsis cohort's D-dimer was slightly lower and more homogeneous (difference not statistically significant).
Conclusions:
Pediatric bacterial infection and COVID-19 exhibit distinct inflammatory marker profiles. Sepsis induces a more intense CRP and ESR response, whereas COVID-19 is characterized by markedly elevated fibrinogen and variable D-dimer levels.
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