DIAGNOSTIC OF C-REACTIVE PROTEIN IN FEBRILE CHILDREN

Abstract

The measurement of C-reactive protein (CRP), an acute-phase protein synthesized by hepatocytes, is valuable to distinguish bacterial
infection from non-bacterial infections in children. The aim of this study is to know the diagnostic properties of quantitative CRP
associated with clinically bacterial and non-bacterial infection in febrile children. Febrile children which was studied were presenting
in the Paediatric Emergency Department, their ages were up to 12 years, with axillary's temperature ≥38.5° C, and the clinically
undetectable source of fever were enrolled in this consecutive study from September, 2009, up to August, 2010. Informed consent was
obtained for the use of CRP evaluation. The CRP concentration was measured with immunoturbidimetry method (Pure auto S CRP latex
(SS-type), Sekisui Medical Co., Ltd) and an auto photometer TMS 1024i. The main outcome result was the presence of the laboratory
examination results, blood culture, or radio graphically. The receiver operator characteristic (ROC) curve was modelled for quantitative
CRP to identify the optimal test value. Eighty-six patients were enrolled in this study. Forty-one (47.6%) had bacterial infection and 45
(52.3%) had non-bacterial infection. The CRP concentration was significantly different between the two groups (p=0.003). The ROC
analysis demonstrated an area under curve (AUC) 0.689, standard error (SE) 0.059, and 95% confidence interval (CI): 0.573-0.805.
The optimal cut-off point for CRP in this data set at 5 mg/L, achieved sensitivity of 0.61, specificity of 0.71, and likelihood ratio 2.11
(Kappa 0.003, McNemar 0.711) for the detection of bacterial infection in this population. The Quantitative CRP concentration is a
valuable laboratory test for the evaluation of febrile children who are at risk of bacterial infection.