VALUE OF ERYTHROCYTE SEDIMENTATION RATE, C-REACTIVE PROTEIN AND PROCALCITONIN CONCENTRATION VERSUS MULTIMARKER STRATEGY IN MANAGEMENT OF BRONCHIOLITIS IN PEDIATRIC EMERGENCY

Abstract

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.