C-reactive Protein In Children Research Articles

A Phenome-Wide Association Study (PheWAS) of Genetic Risk for C-Reactive Protein in Children of European Ancestry: Results From the ABCD Study.

C-reactive protein (CRP) is a moderately heritable marker of systemic inflammation that is associated with adverse physical and mental health outcomes. Identifying factors associated with genetic liability to elevated CRP in childhood may inform our understanding of variability in CRP that could be targeted to prevent and/or delay the onset of related health outcomes. We conducted a phenome-wide association study (PheWAS) of genetic risk for elevated CRP (i.e. CRP polygenic risk score [PRS]) among children genetically similar to European ancestry reference populations (median analytic n = 5,509) from the Adolescent Brain and Cognitive Development℠ (ABCD) Study. Associations between CRP PRS and 2,377 psychosocial and neuroimaging phenotypes were estimated using independent mixed effects models. Post hoc analyses examined whether: (1) covarying for measured body mass index (BMI) or removing the shared genetic architecture between CRP and BMI altered phenotypic associations, (2) sex moderated CRP PRS associations, and (3) associations are unconfounded by assortative mating or passive gene-environment correlations (using a within-family analyses). Multiple testing was adjusted for using Bonferroni and false discovery rate (FDR) correction. Nine phenotypes were positively associated with CRP PRS after multiple testing correction: five weight- and eating-related phenotypes (e.g. BMI, overeating), three phenotypes related to caregiver somatic problems (e.g. caregiver somatic complaints), as well as weekday video watching (all ps = 1.2 × 10-7 - 2.5 × 10-4, all p FDR s = 0.0002 - 0.05). No neuroimaging phenotypes were associated with CRP PRS (all ps = 0.0003 - 0.998; all p FDR s = 0.08 - 0.998) after correction for multiple testing. Eating and weight-related phenotypes remained associated with CRP PRS in within-family analyses. Covarying for BMI resulted in largely consistent results, and sex did not moderate any CRP PRS associations. Removing the shared genetic variance between CRP and BMI attenuated all relationships; associations with weekday video watching, caregiver somatic problems and caregiver report that the child is overweight remained significant while associations with waist circumference, weight, and caregiver report that child overeats did not. Genetic liability to elevated CRP is associated with higher weight, eating, and weekday video watching during childhood as well as caregiver somatic problems. These associations were consistent with direct genetic effects (i.e., not solely due to confounding factors like passive gene-environment correlations) and were independent of measured BMI. The majority of associations with weight and eating phenotypes were attributable to shared genetic architecture between BMI and inflammation. The relationship between genetics and heightened inflammation in later life may be partially attributable to modifiable behaviors (e.g. weight and activity levels) that are expressed as early as childhood.

Expression and significance of procalcitonin, leukotriene B4, serum amyloid A, and C-reactive protein in children with different types of pneumonia: An observational study.

This study aimed to investigate the expression and significance of serum procalcitonin (PCT), leukotriene B4 (LTB4), Serum amyloid A (SAA), and C-reactive protein (CRP) in children with different types of pneumonia caused by different pathogenic infections. One hundred and one children with pneumonia admitted to The Fifth People Hospital of Zhuhai from July 2019 to June 2020 were enrolled and divided into 38 cases in the bacterial group, 30 cases in the mycoplasma group, and 33 cases in the virus group according to the different types of pathogens. The patients were divided into 42 cases in the noncritical group, 33 cases in the critical group, and 26 cases in the very critical group according to the pediatric clinical illness score (PCIS), and 30 healthy children were selected as the control group during the same period. Comparison of serum PCT, SAA: bacterial group > mycoplasma group > viral group > control group with significant differences (P < .05). Receiver operator characteristic (ROC) analysis showed that the area under the curves (AUCs) of serum PCT, LTB4, SAA, and CRP for the diagnosis of bacterial pneumonia were 1.000, 0.531, 0.969, and 0.833, respectively, and the AUCs for the diagnosis of mycoplasma pneumonia were 0.653, 0.609, 0.547, and 0.652, respectively, and the AUCs for the diagnosis of viral pneumonia were 0.888, 0.570, 0.955, and 1.000, respectively. Comparison of serum PCT, LTB4, SAA: very critical group > critical group > noncritical group > control group, with significant differences (P < .05). Serum PCT, LTB4, and SAA were negatively correlated with PCIS score by Pearson analysis (P < .05). Serum PCT and SAA showed diagnostic value for bacterial pneumonia, and serum SAA and CRP showed diagnostic value for viral pneumonia; serum PCT, LTB4, and SAA correlate with severity of disease and show higher expression with worsening of the condition.

Study of Cerebrospinal Fluid C-reactive Protein in Children with Meningitis between 1 Month and 12 Years of Age

Background: India is a growing nation with few resources and trained workers, especially in terms of outlying infrastructure. As a result, a simple and thorough examination to identify acute bacterial meningitis is required. Regular use of cerebrospinal fluid C-reactive protein (CSF-CRP) in the diagnosis of acute bacterial meningitis may be a quick, accurate, and simple way to diagnose meningitis. As a result, the goal of this study is to examine the specificity, sensitivity, positive and negative predictive values, and diagnostic accuracy of CSF-CRP in the diagnosis of bacterial meningitis. Methodology: In a tertiary care center’s department of pediatrics, between January 2021 and June 2022, a cross-sectional descriptive observational study was carried out. Patients’ demographic data such as age, gender, clinical profile, CSF-CRP, and outcome were recorded. In the current study, each subject underwent a complete examination and comprehensive history before a provisional diagnosis was provided. As part of the diagnostic process, blood and CSF samples were taken. A quantitative immunoturbidometric method was used to determine the level of CSF-CRP. Outcome of the Study: Approximately 130 patients with a history of fever, convulsions, and signs of meningitis were considered, out of which 60 (46.2%) patients were male and 70 (53.8%) patients were female. The majority of cases were found to be positive in the CSF-CRP test, i.e. around 52 (60%), while the distribution based on the CSF culture report showed that 17 cases were positive. The results demonstrated that the CSF-CRP had a sensitivity of 100%, indicating that it correctly identified all positive cases. However, its specificity was 69.02%. Results: Notably, 94.2% of pyogenic meningitis cases had positive CSF-CRP results, while viral meningitis cases had no positive results, and tubercular meningitis had a lower 5.8% positive rate. CSF-CRP was also linked to clinical outcomes, with a significantly higher mortality rate of 9.6% in CSF-CRP positive cases. Conclusion: For the diagnosis of pyogenic meningitis, the culture and Gram stain of CSF is the gold standard. Thus, the early diagnosis of pyogenic meningitis and CSF-CRP is useful and decreases the economic burden and hospital stay of the patients.

Evaluating the Utility of Procalcitonin and C-Reactive Protein to Predict Bacteremia in Children with Musculoskeletal Infections

Background:Musculoskeletal infections (MSKI; osteomyelitis, septic arthritis) are among the most common invasive bacterial infections in children, often associated with complications. Bacteremia precedes these complications; thus, early identification may prevent them. Acute inflammatory markers, C-reactive protein (CRP) and Procalcitonin (PCT) are often elevated in children with acute MSKI. PCT is understudied in children with MSKI. The primary goal of this study was to evaluate the utility of PCT and CRP in distinguishing children with MSKI with bacteremia vs. those without.&#x0D; Methods:Patients 6 months to 18 years with strong clinical suspicion of MSKI were prospectively enrolled at Riley Hospital for Children from July 2019 to May 2022 unless clinical evidence suggested an alternative diagnosis or if informed consent was not obtained. CRP was obtained at admission and PCT was collected within 96 hours of presentation to the hospital. Demographic data was recorded from electronic medical records. Two-sided P values of &lt;0.05 were considered statistically significant for univariate analysis and logistic regression.&#x0D; Results:Thirty-seven patients were enrolled, the majority being non-Hispanic white males (40.5%), median age of 8 years (IQR, 4-12). Median PCT in children with bacteremia was higher (0.41 ng/mL [IQR 0.14-0.8 ng/mL]) compared to those without (0.10 ng/mL [IQR 0.05-0.31 ng/mL]) (p=0.03). Median CRP in children with bacteremia was higher (13.7 mg/dL [IQR, 9.15-19.9]) compared to those without (4.1 mg/dL, [IQR 0.65-5.8]) (p&lt;0.01). Both PCT and CRP showed good ability to discriminate those with bacteremia from those without, with an area under the ROC of 0.75 (95% CI 0.56, 0.94) and 0.80 (95% CI 0.64, 0.95), respectively.&#x0D; Conclusions:Initial PCT and CRP demonstrated utility in detecting bacteremia in patients presenting with MSKIs. This study warrants further exploration into the usage of PCT and CRP as early predictors of bacteremia for more appropriate treatment and potentially fewer complications of these infections in pediatric patients.

Combinatorial Host-Response Biomarker Signature (BV Score) and Its Subanalytes TRAIL, IP-10, and C-Reactive Protein in Children With Mycoplasma pneumoniae Community-Acquired Pneumonia.

Host-response biomarkers to differentiate bacterial from viral etiology in children with respiratory infections have shown high accuracies, but are understudied in Mycoplasma pneumoniae (Mp) infections. We compared BV scores (0-34 indicating viral etiology, and 66-100 indicating bacterial etiology), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL; pg/mL), interferon-γ inducible protein 10 (IP-10; pg/mL), and C-reactive protein (CRP; mg/L) serum levels between Mp-positive (Mp+) and Mp-negative (Mp-) community-acquired pneumonia (CAP) patients. We performed receiver operating characteristic (ROC) curve analyses for clinical features and biomarkers. Of 80 CAP patients (median age, 6.3 years; 57.5% male), 26 had Mp+CAP. In Mp+CAP patients, compared to Mp-CAP patients, BV scores were lower (14.0 [3.0-27.8] vs 54.0 [12.0-84.8]; P = .0008), TRAIL levels were higher (86.5 [67.4-123.0] vs 65.5 [42.5-103.9]; P = .025), CRP levels were lower (12.9 [4.0-22.3] vs 36.7 [13.0-132.8]; P = .0019), and IP-10 levels were comparable (366.0 [150.2-603.8] vs 331.0 [154.3-878.8]; P = .73) (all median [interquartile range]). ROC analyses yielded a comparable discriminatory accuracy for the combination of age, fever duration, and duration of respiratory symptoms, with either procalcitonin or BV score (area under the ROC curve, 0.87 vs 0.86; P = .94). Children with Mp+CAP have atypically low, viral levels of the BV score, underscoring the complementary role of microbiological testing.

Retracted: Diagnostic Value of the Triple Combination of Serum Heparin-Binding Protein, Procalcitonin, and C-Reactive Protein in Children with Acute Bacterial Upper Respiratory Tract Infection.

[This retracts the article DOI: 10.1155/2022/1877960.].

Diagnostic Value of Serum Amyloid A and C-Reactive Protein in Children with Mycoplasma pneumoniae Infection.

Diagnostic Value of Serum Amyloid A and C-Reactive Protein in Children with Mycoplasma pneumoniae Infection.

Effect of vitamin D supplementation on brain waves, behavioral performance, nitric oxide, malondialdehyde, and high-sensitivity C-reactive protein in children with attention deficit/hyperactivity disorder: study protocol for a randomized clinical trial

BackgroundAttention deficit/hyperactivity disorder (ADHD) is the most common chronic mental and behavioral disorder among children. Some studies showed the lower levels of vitamin D in patients with ADHD compared with the healthy people. Few clinical trials were conducted in this field. The present study will be performed to examine the effect of vitamin D supplementation in children with ADHD.MethodsWe will conduct a double-blind, randomized controlled clinical trial to investigate the effect of vitamin D supplementation on brain waves, behavioral performance, serum nitric oxide, malondialdehyde, and high-sensitivity C-reactive protein in 50 patients with ADHD. The intervention group will receive one capsule 50,000 IU vitamin D every week, for 8 weeks. The control group will receive one placebo capsule containing 1000 mg olive oil every week. Electroencephalography will be performed for 10 min using Brain Master Discovery from 19 scalp sites both before the first intervention and the 10 sessions of the therapy. The artifact-free periods of 1-min electroencephalography data will be analyzed for quantitative electroencephalography measures.DiscussionFor the first time, this clinical trial will evaluate the effect of vitamin D supplementation on brain waves, serum nitric oxide, malondialdehyde, and high-sensitivity C-reactive protein in patients with ADHD. The results of the present clinical trial will provide a better vision about the vitamin D efficacy in patients with ADHD.Trial registrationRegistered on 5 November 2020 at Iranian Registry of Clinical Trials with code number IRCT20200922048802N1 (https://www.irct.ir/trial/51410).

C-REACTIVE PROTEIN AS A BIOCHEMICAL CRITERION OF A GENERAL INFLAMMATORY SYNDROME IN LYME DISEASE IN CHILDREN

The aim of the study – to improve the methods of non-specific biochemical markers of Lyme disease.&#x0D; Materials and Methods. A group of children (62) aged from 1 to 14 years was observed for the identification of pathogens of blood-borne infections among children. C-reactive protein (CRP) is a protein and acute phase reagent as well as the information base for the interpretation and analysis of clinical observations of CRP.&#x0D; Results and Discussion. There were studied the concentrations of acute-phase response proteins including CRP in children with Lyme disease. We found that circulating of CRP levels as well as concentrations&gt; 3 mg/ml was significantly higher in the group of children with Lyme arthritis cohort than in the control group (P &lt;0.05).&#x0D; Conclusions. C-reactive protein concentration is a very useful but non-specific biochemical marker of inflammation, the measurement of which makes an important contribution to the screening of Lyme borreliosis in children.&#x0D; &#x0D; &#x0D;

Value of autotaxin in predicting refractory Mycoplasma pneumoniae pneumonia in children and its correlation with inflammatory cytokines

To study the value of autotaxin (an autocrine motility factor) level in serum and bronchoalveolar lavage fluid (BALF) in predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children and its correlation with interleukin-6 (IL-6), interleukin-8 (IL-8), and C-reactive protein (CRP). A retrospective analysis was performed on 238 children with Mycoplasma pneumoniae pneumonia who were admitted from January 2019 to December 2021. According to disease severity, they were divided into two groups: RMPP (n=82) and general Mycoplasma pneumoniae pneumonia (GMPP; n=156). The two groups were compared in terms of the levels of autotaxin, IL-6, IL-8, and CRP in serum and BALF to study the value of autotaxin level in serum and BALF in predicting RMPP in children, as well as the correlation of autotaxin level with IL-6, IL-8, and CRP in children with RMPP. Compared with the GMPP group, the RMPP group had significantly higher levels of autotaxin, IL-6, IL-8, and CRP in serum and BALF (P<0.05). For the children with RMPP, the levels of autotaxin, IL-6, IL-8, and CRP in serum and BALF in the acute stage were significantly higher than those in the convalescent stage (P<0.05). The receiver operating characteristic (ROC) curve showed that the level of autotaxin in serum and BALF had a good value in predicting RMPP in children, with an area under the curve of 0.874 (95%CI: 0.816-0.935) and 0.862 (95%CI: 0.802-0.924), respectively. The correlation analysis showed that the level of autotaxin in serum and BALF was positively correlated with IL-6, IL-8, and CRP levels (P<0.001). The level of autotaxin in serum and BALF increases and is correlated with the degree of disease recovery and inflammatory cytokines in children with RMPP. Autotaxin can be used as a predictive indicator for RMPP in children.

Determination of the Association Between Serum Ferritin and C-Reactive Protein in Children Presented with Iron Deficiency Anemia in Combined Military Hospital Pathology Department Multan

Objective: To determine association between Serum ferritin and C-reactive protein (CRP) in children having iron scarcity anemia.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Pathology Department, Combined Military Hospital Multan Pakistan, from Jun to Dec 2018&#x0D; Methodology: One hundred and thirty-eight (138) children were consecutively selected as per inclusion and exclusion criteria. Each sample of blood was collected from children for serum ferritin, Blood complete picture (Blood CP) which include hemoglobin level and red blood cell indices and serum sample for C-reactive protein (CRP). Sandwich chemilumine-scence immunoassay technique was used to analyze serum ferritin, Blood CP was analyzed on sysmex and C-reactive protein was analyzed immuneturbidi-metric method.&#x0D; Result: A total of 138 children were included in our study. Mean age group of our population is 4.5 ± 0.65 years. Out of these 138, 67 (49%) were male children and 71 (51%) were female children. CRP was found negative in 50 (36%) and positive in 88 (64%) children. ANOVA and chi-square test showed association between CRP and anemia was statically significant.&#x0D; Conclusion: Increased ferritin level, secondary to inflammation may mask an underlying iron inadequacy in children. CRP in children with normal or high ferritin can be helpful in diagnosing iron deficiency. Serum ferritin was found to be positively correlated with CRP in children.

C-Reactive Protein Levels in Children with Acute Bronchiolitis.

Results Of 287 patients, 229 (79.2%) were included. 132 (57.6%) were males. Median presentation age was 3.7 (interquartile range (IQR), 1.27-12.33) months. Median CRP level was 10.4 (IQR, 2.8-35.1) mg/L. CRP was high in 167 (72.9%) patients. 17.6% (33/187 patients) had confirmed bacterial coinfection. Respiratory syncytial virus (RSV) was detected in 84 (36.7%) patients. Mean CRP level was higher in RSV-negative compared to RSV-positive patients, 31.3 ± 44.3 versus 21.5 ± 27.7 mg/L, respectively (P = 0.042). Respiratory viral serology profile was positive in 34.7% (17/49 patients). 66.9% (107/160 patients) had positive chest X-ray. Antibiotics were used in 78.1% (179/227 patients). Thirteen (5.7%) patients required intensive care, five (2.2%) had surgical intervention, four (1.8%) required endotracheal intubation, and four (1.8%) died. Patients with high CRP were older at presentation (P < 0.0001) and had more fever (P < 0.0001) and cough (P = 0.002), but lower hemoglobin level (P < 0.0001) compared to those with normal CRP. Fever (P = 0.016) and hemoglobin level (P = 0.002) were independent factors. Conclusion Most children with acute bronchiolitis had high rate of elevated CRP values that did not correlate with the rate of bacterial coinfection. High CRP levels were found in older children, those presented with more fever and cough, and had a lower hemoglobin level despite that those factors were previously reported to be associated with disease severity and bacterial coinfection. This study also showed a high overall rate of antibiotic prescriptions in mostly viral disease.

Diagnostic Value of the Triple Combination of Serum Heparin-Binding Protein, Procalcitonin, and C-Reactive Protein in Children with Acute Bacterial Upper Respiratory Tract Infection.

To investigate the role of the triple combination serum heparin-binding protein (HBP), procalcitonin (PCT), and C-reactive protein (CRP) in children with acute bacterial upper respiratory tract infection (ABURTI). A total of 130 children with upper respiratory tract infection admitted to the Department of Pediatrics of Fujian Maternity and Child Health Hospital from September 2019 to January 2021 were selected as the research group. According to the results of pathogenic analysis, children were further subdivided into a bacterial infection group (n = 67) and a viral infection group (n = 63). Additionally, 65 children who underwent physical examinations in our hospital during the same period were collected and included into the control group (n = 65). All patients selected were treated with cefixime granules orally for 5 days. Serum HBP level, serum PCT level, and serum CRP level were measured by double antibody Sandwich Enzyme Linked Immunosorbent Assay (ELISA), fluorescence method, and immunoturbidimetric assay, respectively. The expression levels of the three indicators in the serum of all subjects were compared, and the receiver operating characteristic (ROC) curve was used to analyze their diagnostic value in children with ABURTI. Furthermore, according to clinical efficacy of children with bacterial infections, they were divided into a good efficacy group (markedly effective) and a poor efficacy group (effective + ineffective) to compare serum HBP, PCT, and CRP levels between the two groups. The ROC curve was drawn to analyze the value of the three indicators in predicting the curative effect in children with ABURTI. Pearson test was used to analyze the correlation among the expression of HBP, PCT, and CRP. Results showed that the expression levels of HBP, PCT, and CRP in the serum of children in the bacterial infection group were significantly higher than those in the other two groups. The positive rates of HBP, PCT, and CRP in children in the bacterial infection group were also significantly higher than those of the other two groups. The area under the curve (AUC) of the combined diagnosis of HBP, PCT, and CRP was 0.973, which was significantly higher than that of the single detection by any of the three indicators, which were 0.849, 0.819, and 0.854, respectively. The expression levels of HBP, PCT, and CRP in the serum of children in the good efficacy group were significantly lower than those in the poor efficacy group, and the AUC of the triple combination for predicting treatment efficacy was 0.959. Pearson test showed that there was a positive correlation between the serum expression of HBP, PCT, and CRP in children. HBP, PCT, and CRP were highly correlated in children with ABURTI, and their combined detection was of high diagnostic value among ABURTI patients, indicating that the three were expected to become potential indicators for efficacy prediction.

C-Reactive Protein and the Outcome of a Pediatric Emergency Department 7 Days Revisit.

Pediatric emergency department (PED) return visits represent an important quality of care metric and constitute a patient-centered outcome. C-reactive protein (CRP) is an inflammatory biomarker that is commonly used as screening tool in the PED. In this study, we assessed the clinical outcomes of children whose levels of CRP are 150 mg/L or higher at the initial PED visit and if such levels could be useful in predicting outcomes at a second PED visit. A historical cohort study of all patients who visited the PED between July 2007 and June 2017 and had a CRP value of 150 mg/L or greater in the setting of a febrile illness. Data of patients with a return visit to the PED within 7 days were assessed for an association between laboratory values, diagnosis and clinical outcome. One hundred thirty-six index visits were included in this study. One hundred fifteen (84.6%) of the revisits were discharged after their second visit, and 21 (15.4%) were admitted to the inpatient unit. Admitted patients did not differ from patients who were discharged home in diagnosis and CRP levels, but a difference in white blood cell and absolute neutrophil counts was observed. The intensity of the inflammatory response, as expressed by the high concentrations of CRP in children, does not seem to predict the outcome at a repeat PED visit within 7 days.

Predictive Value of C-Reactive Protein for Early Postoperative Complications in Children After Hypospadias Surgery.

Background: This study explored the predictive value of postoperative C-reactive protein in children with hypospadias for postoperative complications and the risk factors.Methods: The clinical and follow-up data of 106 children with hypospadias who were treated with operations at Kunming Children's Hospital in 2020 were, respectively, analyzed. According to the occurrence of postoperative complications, the patients were divided into two groups: 25 patients with postoperative complications were the complications group, and 81 without postoperative complications were the control group. The baseline data, clinical characteristics, laboratory test indexes, and outcome of the two groups were collected. Receiver operating characteristic (ROC) was used to calculate the optimal cutoff value of C-reaction protein (CRP). Logistic regression was used to analyze the risk factors of hypospadias after surgery. A probability value (P) < 0.05 was considered statistically significant.Results: According to the result of the ROC curve, the optimal cutoff value of CRP was 11.7 mg/L. Logistic regression showed that the length of urethral defect, the urethral material, the operative produce, and the postoperative CRP level were related to the occurrence of postoperative complications of patients with DCC. The length of the urethral defect and the CRP level were the independent risk factors of the prognosis of hypospadias patients. The CRP level was related to the occurrence of postoperative complications and fistula.Conclusions: Postoperative CRP level can be used as a reliable marker for predicting the prognosis of hypospadias patients.

Diagnostic test accuracy of serum procalcitonin compared with C-reactive protein for bone and joint infection in children and adolescents: a systematic review and meta-analysis.

The objective of this review was to synthesize the best available evidence for the diagnostic test accuracy of serum procalcitonin compared with serum C-reactive protein for suspected osteomyelitis and septic arthritis in hospitalized children and adolescents. Measurement of serum C-reactive protein remains a routine investigation for the diagnosis of osteoarticular infection in children and adolescents. Measurement of serum procalcitonin has been shown to outperform C-reactive protein in adults with osteomyelitis and septic arthritis. Before procalcitonin can be considered as a potential replacement or add-on test in children and adolescents, a systematic review and meta-analysis targeting this population should be conducted. Original studies reporting the diagnostic accuracy of procalcitonin and/or C-reactive protein in children and adolescents between one month and 18 years of age admitted to hospital with suspected osteoarticular infection were included. Studies must have compared the index test to at least one reference test. Reference test was defined as positive culture or polymerase chain reaction confirmation of a pathogen from blood, bone biopsy, or joint fluid aspirate in combination with at least two of the following: i) purulent material from sterile site, ii) positive radiological findings consistent with osteoarticular infection, and ii) symptoms and signs consistent with osteomyelitis and/or septic arthritis. The JBI methodology for systematic reviews of diagnostic test accuracy was followed. Information was sourced from four databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) and four gray literature sources (MedNar, OpenGrey, Google Scholar, and ProQuest Dissertations and Theses). Only studies published in English were considered. The methodological quality of selected studies was formally evaluated, sensitivity and specificity data were extracted, and 95% confidence intervals determined. Meta-analysis was performed to estimate summary points using a bivariate model and to generate a hierarchical summary receiver operating characteristic (HSROC) curve with global measures of test accuracy performance, such as likelihood ratio and diagnostic odds ratio. A narrative was provided where meta-analysis was not appropriate. Eight studies were included in the review. Four of these studies used a common C-reactive protein test threshold of 20 mg/L. At this threshold, the estimated pooled sensitivity of C-reactive protein was 0.86 (0.68-0.96) and the pooled specificity was 0.9 (0.83-0.94). Using a hierarchical summary receiver operating characteristic model from six studies, the diagnostic odds ratio for C-reactive protein was estimated to be 39.4 (14.8-104.9) with a positive likelihood ratio 5.3 (2.3-11.9) and a negative likelihood ratio 0.1 (0.07-0.2). There were insufficient studies from this review to statistically evaluate the diagnostic accuracy of procalcitonin. Clinicians should continue to measure serum C-reactive protein as the preferred inflammatory marker in hospitalized children and adolescents with suspected osteomyelitis or septic arthritis. More evidence is needed before incorporating procalcitonin routinely into clinicians' diagnostic test strategy. Improvements with the design, quality, and reporting of procalcitonin diagnostic test assays in children and adolescents with osteoarticular infection is needed. PROSPERO CRD42019140276.

C-reactive protein in children with obstructive sleep apnea and effects of adenotonsillectomy

ObjectiveC-reactive protein (CRP) is an important serum marker of inflammation associated with cardiovascular outcomes. This study aims to evaluate the association between CRP and childhood obstructive sleep apnea (OSA) and clarify the effects of adenotonsillectomy on serum CRP levels in children with OSA. MethodsChildren with symptoms suggestive of OSA who underwent an overnight polysomnography were recruited from a tertiary medical center. Their serum CRP levels were measured. For children who underwent adenotonsillectomy for OSA treatment, polysomnography and serum high-sensitivity CRP (hs-CRP) level measurement were conducted after surgery. ResultsThis study included 326 children (mean age: 7.2 ± 3.0 years; boys: 67%). Children with apnea-hypopnea index (AHI) > 5 events/h had significantly higher hs-CRP levels than children with AHI of 1–5 events/h and AHI < 1 event/h [median (interquartile range): 0.08 (0.03–0.25) vs 0.03 (0.02–0.14) vs 0.04 (0.01–0.10), P < 0.001]. Log-transformed hs-CRP levels were positively associated with log AHI values (r = 0.2, P < 0.001). In multiple linear regression analysis, hs-CRP levels were independently associated with AHI; 101 children with OSA (ie, AHI > 1) underwent adenotonsillectomy. In children with OSA in the study cohort, a significant reduction of hs-CRP levels did not occur after surgery [from 0.07 (0.02–0.22) to 0.08 (0.03–0.17), P = 0.716]. In children with OSA having abnormal hs-CRP levels (ie, CRP > 1 mg/dL), hs-CRP levels significantly decreased after surgery [from 1.87 (1.11–2.78) to 0.20 (0.07–1.04), P = 0.043]. ConclusionChildren with OSA had increased hs-CRP levels. Children with OSA and abnormal hs-CRP levels exhibited significantly reduced hs-CRP levels following adenotonsillectomy.

Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

BackgroundThe diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis.ResultsThe ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001.ConclusionAlvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

Parents' use of extreme physical violence is associated with elevated high-sensitivity C-reactive protein in children

BackgroundChildren who grow in settings where parenting is harsh tend to develop a response tendency that may give rise to a chronic pro-inflammatory state. Thus, we aimed to identify if experiencing abuse triggers an increase in the child high sensitivity C-reactive protein (hs-CRP) in a population birth cohort, Generation XXI. MethodsAt cohort participants age of 7 years, information on parents’ disciplinary practices was collected by trained interviewers using the Conflict Tactics Scale Parent-Child version. Venous blood samples were obtained after overnight fast and hs-CRP was quantified. ResultsOf 4175 participants, 44.0% of children reported low frequency of physical violence, 50.1% reported frequent but not severe physical violence, 5.3% reported frequent and severe physical violence, and 0.6% children reported parental extreme physical violence. Higher levels of hs-CRP were observed among children who reported the highest grade of violence severity (58.3%). After adjustment for child's sex, age and parental education, the increasing grade of violence severity increased the odds of higher hs-CRP levels. LimitationsNo significant increase in the levels of hs-CRP was found in children exposed to less severe violence. However that does not mean that those forms of violence have no impact on health in the long-term period. Also, the cross-sectional nature of the study prevents us from concluding the directionality of the effects, although we provided theoretical arguments for the proposed pathway. ConclusionsChildren physically abused by their parent(s) present heightened inflammation levels. Thus, our results show that stressful events may impact inflammatory processes even at very early ages.

Respiratory tract damage with bocavirus infection in children

Long time the main pathogens associated with the development of community-acquired pneumonia were bacteria. However, in recent years in the Russian Federation, like all over the world, the view of the damage of lower respiratory tract changed, including a unique approach to community-acquired pneumonia as a bacterial infection, and respiratory viruses have become seen as a direct cause of lower respiratory tract damage, or as part of a viral-bacterial co-infection. These studies became possible since the widespread introduction of PCR techniques in the clinical setting, identification of respiratory viruses has increased and new microorganisms such, one as human bocavirus have been discovered. Objective: to study the features of respiratory tract damage in acute bocavirus infection in children of different ages. Materials and methods: A retrospective analysis of 97 medical hospital documentation of children with acute bocavirus infection, detected confirmed by PCR in nasopharyngeal aspirate. Results: In this work, it was shown that human bocavirus spread throughout the year with an increase in the incidence of clinically significant forms in the autumnwinter period, including during the period of an increase in the incidence of influenza. HBoV infection requiring hospitals is most significant in the first three years of life. In 74.2% of hospitalized children, bocavirus infection occurs with lower respiratory tract infections in the form of bronchitis — 77.8%, pneumonia — 28.9% and rarely bronchiolitis and is complicated by the development of respiratory failure in 28.9% of cases. Changes in the blood test are non-specific, and the level of C-reactive protein in children with various clinical manifestations of HBoV infection generally does not exceed 50 mg / l. An x-ray of the chest organs does not objectively reflect the existing volume and nature of the inflammatory process in the lungs.