Clinical implications of extremely elevated C‐reactive protein among febrile immunocompetent children
Shirley Saar, Oded Scheuerman, Tarek Zuabi, Gil Amarilyo, Mor Abu, Lotem Goldberg, Bar Goldberg, Nina Shirman, Yoav Vardi, Yehonatan Pasternak, Yoel Levinsky- General Medicine
- Pediatrics, Perinatology and Child Health
Abstract
Aim
To identify the various diagnoses associated with extremely elevated C‐reactive protein (CRP) (>30 mg/dL) among immunocompetent children and to evaluate its clinical implications during emergency department (ED) workup and hospital management.
Methods
Children (3 months–18 years) with fever in ED were included, retrospectively. The cohort was divided into two groups—‘extremely elevated CRP’ (>30 mg/dL) and ‘highly elevated CRP’ (15–30 mg/dL).
Results
Included were 1173 patients with CRP 15–30 mg/dL and 221 with CRP > 30 mg/dL. Bacterial infection was more prevalent among the extremely elevated CRP group (94.1% vs. 78.5%, respectively, p = 0.002). Specifically, bacterial pneumonia (52%), cellulitis (7.2%) and sepsis (4.1%) were more prevalent among this group. More of these patients were reported as ‘Ill appearing’ [78 (35.3%) vs. 166 (17.4%), p < 0.001]. They were more often treated with fluids [33 (14.9%) vs. 50 (5.3%), p < 0.001] and a higher portion of them required admission to an intensive care unit [11 (5.0%) vs. 16 (1.7%), p = 0.007].
Conclusion
Febrile children with extremely elevated CRP showed greater illness severity (haemodynamic instability, PICU admissions), thus careful clinical attention is desirable in these cases. More than half of them had bacterial pneumonia, which reinforces the importance of relevant investigation when diagnosis is unclear.