VALUE OF ERYTHROCYTE SEDIMENTATION RATE, C-REACTIVE PROTEIN AND PROCALCITONIN CONCENTRATION VERSUS MULTIMARKER STRATEGY IN MANAGEMENT OF BRONCHIOLITIS IN PEDIATRIC EMERGENCY
DOI:
https://doi.org/10.12775/v10251-012-0025-7Keywords
erythrocyte sedimentation rate, C-reactive protein, procalcytonin, bronchiolitisAbstract
Background. Accurate discrimination between viral and bacterial infection is important in children with bronchiolitis. During the viral infection the symptomatic treatment is the most important but in the presence of bacterial infection or co-infection the use of guided antibiotics should be started as soon as possible to avoid complications.
Materials and methods. The efficacy of CRP, PCT and ESR tests was analyzed in 149 children with clinical symptoms of viral (group A) or bacterial co-infection (group B).
Results. In the whole group the normal values of CRP, PCT and ESR were found in 75% of children. In group A normal values of all markers were found in 95%, whereas only in 42% of those in group B. The area under the receiver operating characteristic (ROC) curve (AUC) for distinguishing groups CRP was 0.63 (SE 0.059, 95% CI 0.51 to 0.75). AUC calculated for PCT was 0.67 (SE 0.06, 95% CI 0.55 to 0.79) and for ESR it was 0.71 (SE 0.058, 95% CI 0.60 to 0.83). P values calculated for AUCs’ in comparison to CRP, PCT and ESR CRPxPCT were 0.2862, 0.5564 and 0.9047, respectively, for CRPxESR 0.2311, 0.4487 and 0.7418, respectively and for PCTxESR - 0.3157, 0.5492 and 0.8398, respectively.
Conclusions. Results suggest that value of multimarker strategy with the use of CRP, ESR, PCT is comparable to single test in distinguishing bacterial co-infection from viral etiology, thus single biochemical tests may help to make decisions about antibiotic therapy in children with bronchiolitis in pediatric emergency.
References
Chehab MS, Bafagih HA, Al-Dabbagh MM: Overview of bronchiolitis. Saudi Med J. 2005;26:177-190. http://www.ncbi.nlm.nih.gov/pubmed/15770289
Kotagal UR, Robbins JM, Kini HD, Kirschbaum MS: Impact of bronchiolitis guideline – a multisided demonstration project. Chest 2002; 121: 1789-1797. DOI: http://dx.doi.org/10.1378/chest.121.6.1789
Everard ML: Bronchiolitis. Origins and optimal management. Drugs, 1995; 49: 885-896. DOI: http://dx.doi.org/10.2165/00003495-199549060-00003
Wolf DG, Greenberg D, Kalkstein D, Shemer-Avni Y, Givon-Lavi N, Saleh N, Goldberg MD, Dagan R.: Comparison of human metapneumovirus, respiratory syncytial virus and influenza A virus lower respiratory tract infections in hospitalized young children. Pediatr Infect Dis J. 2006;25:320-324. DOI: http://dx.doi.org/10.1097/01.inf.0000207395.80657.cf
Gendrel D, Raymond J, Coste J, Moulin F, Lorrot M, Guérin S, Ravilly S, Lefèvre H, Royer C, Lacombe C, Palmer P, Bohuon C.: Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentiation of bacterial vs viral infections. Pediatr Infect Dis J. 1999;18:875-881. DOI: http://dx.doi.org/10.1097/00006454-199910000-00008
Melbye H, Hvidsten D, Holm A, Nordbø SA, Brox J: The course of C-reactive protein response in untreated upper respiratory tract infection. Br J Gen Pract. 2004;54:653-658. http://www.ncbi.nlm.nih.gov/pubmed/15353049
Urbach J. Shapira I, Branski D, Berliner S.: Acute phase response In the diagnosis of bacterial infectious in children. Pediatrc. Infect. Dis. J. 2004; 23: 157-160.
Melbye H, Stocks N.: Point of care testing for C-reactive protein - a new path for Australian GPs? Aust Fam Physician. 2006;35:513-517. http://www.ncbi.nlm.nih.gov/pubmed/16820825
Hatherill M, Tibby SM, Sykes K, Turner C, Murdoch IA.: Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child. 1999;81:417-421. DOI: http://dx.doi.org/10.1136/adc.81.5.417
Korppi M, Heiskanen-Kosma T, Leinonen M.: White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. Eur Respir J. 1997;10:1125-129. DOI: http://dx.doi.org/10.1183/09031936.97.10051125
Putto A, Ruuskanen O, Meurman O, Ekblad H, Korvenranta H, Mertsola J, Peltola H, Sarkkinen H, Viljanen MK, Halonen P.: C reactive protein in the evaluation of febrile illness. Arch Dis Child. 1986;61:24-29. DOI: http://dx.doi.org/10.1136/adc.61.1.24
Scottish Intercollegiate Guidelines Network, Bronchiolitis in children, A national Clinical guideline, http://www.sign.ac.uk, 2008.
Freymuth F, Vabret A, Legrand L, Dina J, Gouarin S, Cuvillon-Nimal D, Brouard J.: Human metapneumovirus. Pathol Biol. 2009;57:133-141. DOI: http://dx.doi.org/10.1016/j.patbio.2008.04.005
Prat C, Dominiquez J., Rodrigo C., Gimenz M., Kazuara M., Jimenez O., Gali N., Ausina V.: Procalcitonin, Creactive protein and leucocyte count in children with lower respiratory tract infection; Pediatr Infect Dis J. 2003; 22: 963-968. DOI: http://dx.doi.org/10.1097/01.inf.0000095197.72976.4f
Analyse-it Software, Ltd. http://www.analyse-it.com/;2008
Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A.: Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003;31:1737-1741. DOI: http://dx.doi.org/10.1097/01.CCM.0000063440.19188.ED
Rey C, Los Arcos M, Concha A, Medina A, Prieto S, Martinez P, Prieto B.: Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intensive Care Med. 2007;33:477-484. http://www.ncbi.nlm.nih.gov/pubmed/17260130
Costa S, Rocha R, Tavares M, Bonito-Vítor A, Guedes-Vaz L.: C Reactive protein and disease severity in bronchiolitis.Rev Port Pneumol. 2009;15:55-65. http://www.ncbi.nlm.nih.gov/pubmed/19145387
Moulin F, Raymond J, Lorrot M, Marc E, Coste J, Iniguez JL, Kalifa G, Bohuon C, Gendrel D.: Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child. 2001;84:332-336. DOI: http://dx.doi.org/10.1136/adc.84.4.332
Saijo M, Ishii T, Kokubo M, Murono K, Takimoto M, Fujita K.: White blood cell count, C-reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract. Acta Paediatr Jpn. 1996;38:596-600. DOI: http://dx.doi.org/10.1111/j.1442-200X.1996.tb03714.x
Ahn S, Kim WY, Kim SH, Hong S, Lim CM, Koh Y, Lim KS, Kim W.: Role of procalcitonin and C-reactive protein in differentiation of mixed bacterial infection from 2009 H1N1 viral pneumonia. Influenza Other Respi Viruses. 2011 Mar 30. DOI: http://dx.doi.org/10.1111/j.1750-2659.2011.00244.x
Korppi M.: Non-specific host response markers in the differentiation between pneumococcal and viral pneumonia: what is the most accurate combination? Pediatr Int. 2004;46:545-550. DOI: http://dx.doi.org/10.1111/j.1442-200x.2004.01947.x
Ip M, Rainer TH, Lee N, Chan C, Chau SS, Leung W, Leung MF, Tam TK, Antonio GE, Lui G, Lau TK, Hui DS, Fuchs D, Renneberg R, Chan PK.: Value of serum procalcitonin, neopterin, and C-reactive protein in differentiating bacterial from viral etiologies in patients presenting with lower respiratory tract infections. Diagn Microbiol Infect Dis. 2007;59:131-136. DOI: http://dx.doi.org/10.1016/j.diagmicrobio.2007.04.019
Kurylak A, Kurylak D, Dylewska K, Kubicka M, Grześk E, Wysocki M, Wojak I: Stężenia prokalcytoniny, interleukiny 6, TNF-Alfa, IFN-Gamma oraz interleukiny 10 w przebiegu zakażeń o etiologii bakteryjnej lub wirusowej u niemowląt. Ann. Acad. Med. Bydg. 2004; 18(4):85-90.
Toikka P, Irjala K, Juvén T, Virkki R, Mertsola J, Leinonen M, Ruuskanen O.: Serum procalcitonin, Creactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J. 2000;19:598-602.
Lacoma A, Prat C, Andreo F, Lores L, Ruiz-Manzano J, Ausina V, Domínguez J.: Value of procalcitonin, Creactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2011;6:157-69.
Prat C, Sancho JM, Dominguez J, Xicoy B, Gimenez M, Ferra C, Blanco S, Lacoma A, Ribera JM, Ausina V.: Evaluation of procalcitonin, neopterin, C-reactive protein, IL-6 and IL-8 as a diagnostic marker of infection in patients with febrile neutropenia. Leuk Lymphoma. 2008;49:1752-61. http://www.ncbi.nlm.nih.gov/pubmed/18661397
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