C-reactive Protein Levels In Children Research Articles

Association of gene polymorphisms of MyD88 and TICAM1 and their interactions with community-acquired pneumonia in children

To investigate the association of single nucleotide polymorphisms (SNPs) of myeloid differentiation factor 88 (MyD88) and Toll-like receptor adaptor molecule 1 (TICAM1) and their interactions with community-acquired pneumonia (CAP) in children. Improved multiple ligase detection reaction assay was used for detecting the polymorphisms of nine tagging SNPs of the MyD88 and TICAM1 genes in 375 children with CAP who attended the Department of Pediatrics of the Second Affiliated Hospital of Yan'an University Medical School from August 2015 to September 2017 and 306 healthy children who underwent physical examination. A logistic regression analysis was used to evaluate the association between the distribution of genotypes and their interactions with CAP in children. The polymorphism of the TICAM1 gene at rs11466711T/C locus was closely associated with the susceptibility to CAP in children (P<0.05). The AA genotype of rs35747610G/A locus significantly reduced risk of sepsis in children with CAP (P<0.05). The AA genotype of rs6510826G/A locus was significantly associated with the increase in C-reactive protein level in children with CAP (P<0.05). The GG genotype of the MyD88 gene at rs7744A/G locus significantly increased the risk of respiratory failure and circulatory failure (P<0.05). The multiplicative interactions between MyD88 gene rs7744A/G and TICAM1 gene rs11466711T/C, rs2292151G/A, rs35299700C/T, and rs35747610G/A loci were significantly associated with the susceptibility to CAP, the severity of CAP, and the risk of sepsis in children (P<0.05). The gene polymorphisms of MyD88 and TICAM1 and their interactions are closely associated with CAP in children, with a synergistic effect on the development and progression of CAP in children.

Evaluation of procalcitonin and C-reactive protein levels in children with autism spectrum disorder and attention deficit hyperactivity disorder

Inflammation is thought to play a role in the etiopathogenesis of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Procalcitonin (PCT) is an inflammatory biomarker released by thyroid parafollicular cells. CRP is systemic biomarker of inflammation. In this study, the hypothesis that PCT and C-reactive protein (CRP) might be indicators of increased inflammatory response was tested. For this purpose, PCT and CRP as well as other simple inflammatory markers were evaluated in children with ASD and ADHD. A total of 33 ASD, 36 ADHD, and 31 healthy controls were included in the study, who were similar in terms of gender and age. PCT, CRP, sedimentation and hemogram parameters (Neutrophil Lymphocyte Ratio) were measured in children aged 5-15 years. PCT and CRP values were found to be statistically significantly higher in ASD and ADHD children compared to healthy controls (p < 0.05). A positive correlation was found between PCT and CRP values (r: 0.358; p < 0.001). No significant correlations were found between disorder severity scale scores and PCT and CRP values (p > 0.05 for both). Accordingly, it is suggested that inflammation plays a role in the etiopathogenesis of these disorders. PCT and CRP may be used as inflammation markers.

Prediction of coronary artery lesions based on C-reactive protein levels in children with Kawasaki Disease: a retrospective cohort study

ObjectiveSince coronary artery lesions (CALs) are the most severe complication of Kawasaki disease (KD), clinically speaking, early prediction of CALs is crucial. The authors aimed to investigate the predictive value of C-reactive protein (CRP) in predicting CALs in KD patients. MethodsKD patients were divided into the CALs group and the non-CALs group. The clinical and laboratory parameters were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of CALs. The receiver operating characteristic curve was applied to determine the optimal cut-off value. Results851 KD patients who met the inclusion criteria were studied, including 206 in the CALs group and 645 in the non-CALs group. Children in the CALs group had significantly higher CRP levels than the non-CALs group (p < 0.05). Multivariable logistic regression analysis showed that incomplete KD, male, lower hemoglobin, and higher CRP were independent risk factors for predicting CAL (all p < 0.05). The optimal cut-off value of initial serum CRP for predicting CALs was 105.5 mg/L, with a sensitivity of 47.57% and a specificity of 69.61%. In addition, KD patients with high CRP (≥105.5 mg/L) had a higher occurrence of CALs than those with low CRP (<105.5 mg/L) (33% vs 19%, p < 0.001). ConclusionThe incidence of CALs was significantly higher in patients with high CRP. CRP is an independent risk factor for CALs formation and may be useful for predicting CALs in KD patients.

Salivary biomarker C-reactive protein levels in children with sleep problems and Class II malocclusion before and after twin-block therapy.

Disturbances in sleep affects the overall quality of a child's life, with several short- and long-lasting consequences. Hence, early diagnosis and monitoring is crucial in the management of sleep disorders in children. The aim of this study was to evaluate salivary C-reactive protein (CRP) levels in a group of children with Class II malocclusion and sleep problems before and after twin-block appliance therapy. The study was a prospective clinical study with a 9-month follow-up period. Eleven children aged 8-12 years with skeletal Class II malocclusion and at least one sleep disorder were enrolled in the study. All children were subjected to a recording of their sleep history and a clinical as well as radiographic examination. Pretreatment levels of salivary CRP were recorded. A twin-block appliance was custom made and delivered to every child. At the end of 9-month follow-up, all children were recalled for a re-evaluation of salivary biomarker levels. Pretreatment and posttreatment changes in biomarker levels were assessed statistically using the students paired t-test. Levels of salivary biomarker CRP were significantly decreased in children following myofunctional therapy using a twin-block appliance (P < 0.001). There was a considerable improvement in the clinical symptoms such as a decrease in snoring and noisy breathing in most children post-twin-block therapy. The measurement of salivary biomarker CRP could be used as an alternative and noninvasive method to evaluate prognosis of oral myofunctional therapy for children with sleep disordered breathing.

Postoperative kinetics of pentraxin 3 (PTX3) after congenital heart surgery with cardiopulmonary bypass in pediatric patients

BackgroundPentraxins are inflammatory proteins and markers of acute-phase responses. They are divided into short and long subgroups based on the length of the N-terminal region. The most studied short pentraxin is the C-reactive protein (CRP), which is known to be expressed in various inflammatory conditions, including surgical procedures. On the other hand, much less is known about the kinetics of long pentraxin 3 (PTX3) in surgical patients, especially in the pediatric population.The aim of this prospective study was to determine the early postoperative kinetics of PTX3 in relation to procalcitonin (PCT) and CRP levels in children undergoing congenital heart surgery with cardiopulmonary bypass (CPB).MethodsA total of 21 children (9 boys and 12 girls, mean age 12 months) were included in the study. Blood samples for determination of CRP, PCT, and PTX3 levels were collected before the surgery and then immediately after its completion (postoperative day 0, POD 0) and subsequently at POD 1, 2, and 3.ResultsSerum PTX3 concentrations increased significantly between POD 0 and POD 1 (mean values were 12.2 and 72.4 ng/ml, respectively, p<0.001), decreased between POD 1 and POD 2 (mean values were 72.4 and 23.6 ng/ml, respectively, p<0.001), and normalized on POD 3 (the mean value was 1.2 ng/ml).ConclusionsPTX3 concentrations are markedly elevated during the first postoperative day. Under normal circumstances, PTX3 rises and falls quickly, and its second rise in the early postoperative period may be abnormal, however, further studies are necessary.

Combined diagnostic potential of multi-slice spiral CT and serum CRP levels in children with Mycoplasma pneumonia after azithromycin treatment

Purpose: To investigate the combined diagnostic value of multi-slice spiral computerized tomography (MSCT) and serum C-reactive protein (CRP) levels in children with mycoplasma pneumonia (MPP) after azithromycin treatment.Methods: Clinical data for 60 children with MPP who were treated in The First People's Hospital of Chenzhou, Chenzhou from February 2019 to February 2020, were retrospectively analyzed. All children were treated with azithromycin. Serum CRP levels were measured using immunoturbidimetric endpoint assay, while MSCT examination was done before and after treatment. This was a self-control clinical study in which the 60 patients served as their own controls. Thus, results obtained before treatment (control group, CG) were compared with those obtained after treatment (study group, EG). Within the same period, 60 healthy subjects were selected as the healthy group (HG), and were subjected to MSCT examination and serum CRP assay. The diagnostic results of CT were analyzed, and the responsiveness, selectivity, and positive and negative predictive values of the combination of MSCT and serum CRP levels were calculated.Results: Pre-treatment serum CRP level was higher in CG than in EG and HG, and CRP level was higher in EG than in HG (p &lt; 0.001). The MSCT imaging features of EG were significantly different from those of CG (p &lt; 0.05). The probabilities of bronchial wall thickening, hilar and mediastinal lymphadenopathy and pleural effusion were significantly higher in CG than in EG (p &lt; 0.05). The responsiveness, selectivity, and positive and negative predictive values of combination of MSCT and serum CRP in MPP children after azithromycin treatment were 70.0, 66.7, 67.7 and 69.0 %, respectively.Conclusion: The combination of MSCT examination and serum CRP levels resulted in high diagnostic efficiency, and it may be useful for monitoring MPP in children after azithromycin treatment. Therefore, the combined procedure may reduce the burden on families of MPP children by enhancing efficiency of diagnosis of the disease.

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.

Dynamics of leukocytic blood parameters depending on the activity of inflammatory bowel disease in children

Aim: to establish the patterns of changes in leukocyte blood parameters to determine their diagnostic significance in the different activity of Crohn’s disease (CD) and ulcerative colitis (UC) in children. Materials and methods. 370 5-18-year children (198 boys, 172 girls) with inflammatory bowel disease (IBD) were examined. Leukocytic blood parameters, concentrations of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), faecal calprotectin (FC) levels were determined. Changes in clinical activity in Crohn’s disease (CD) and ulcerative colitis (UC) cases were determined using pediatric activity indices: PCDAI and PUCAI, respectively. Analysis of endoscopic activity in 160 CD and UC patients was determined using the scales: SES-CD and UCEIS, respectively. Results. It was found that with an increase in the clinical activity of CD in children, the absolute numbers of leukocytes, lymphocytes and monocytes did not change significantly. In contrast, a significant increase in neutrophil reactivity was noted. In patients with high endoscopic CD activity an increase in the absolute number of monocytes and neutrophil reactivity was found. In patients with high clinical activity of UC, an increase in the number of leukocytes and the absolute number of neutrophils was found. At the same time, the granularity and reactivity of neutrophils increased from remission to moderate and high clinical activity of UC. In children with high endoscopic UC activity, the number of leukocytes, the absolute number of neutrophils and monocytes increased. At the same time, the granularity of neutrophils significantly increased as the endoscopic activity of UC increased from remission to moderate activity. Leukocyte parameters in UC patients correlated moderately with FC level, and the absolute number of neutrophils was closely related to its content. The granularity and reactivity of neutrophils positively correlated with ESR and CRP levels in children with CD and CRP concentrations in children with UC. Conclusion. The established patterns of changes in the quantitative composition of leukocytes and their functional properties (reactivity and granularity) are directly determined by the different activity of IBD in children and have diagnostic value

#83: Leukocytes and C-Reactive Protein Levels in Children with Influenza-positive and Influenza-negative Viral Pneumonia in a Third-level Pediatric Center in Mexico City from 2011 to 2016

BackgroundInfluenza has been a major source of morbidity and mortality worldwide. Children are one of the most susceptible groups for severe influenza. Clinical differentiation between viral and bacterial pneumonia is difficult to assess in children, so the aid of the complete blood count (CBC) and C-reactive protein (CRP) are used to differentiate between them. However, differential diagnosis between influenza-positive and -negative viral pneumonia is difficult. CRP levels have been found to be higher in H1N1 influenza adult patients. However, there are no studies regarding CBC, and CRP levels in pediatric patients with influenza-positive and -negative pneumonia.MethodsFrom 2011 to 2016, we found children less than 18 years old with viral pneumonia who had positive viral RT–PCR test for adenovirus, bocavirus, influenza, parainfluenza, metapneumovirus, rhinovirus, coronavirus or respiratory syncytial virus (RSV). Means for white blood cells (WBC), neutrophils, lymphocytes and CRP were calculated. Comparisons between influenza and other respiratory viral pneumonia WBC and CRP means were made. Student’s t-test was used for statistical analysis.ResultsWe analyzed 183 patients with positive viral pneumonia cases; of which, 37 (20.2%) had two viruses detected. Mean age was 1 year old and 56.5% were male. Viral detections were rhinovirus 75 (40.9%), RSV 45 (24.5%), influenza 31 (16.9%), metapneumovirus 30 (16.3%), bocavirus 20 (10.9%), parainfluenza 14 (7.6%), coronavirus 3 (1.6%) and adenovirus 2 (1.1%). Mean influenza WBC were 10,900 ± 2040/μL, neutrophils were 6998 ± 1510/μL, lymphocytes 2882 ± 826/μL and CRP 5.41 ± 1.9 mg/dL. Mean influenza negative, viral-positive pneumonia were WBC 12227 ± 868/μL, neutrophils 6787 ± 696/μL, lymphocytes 4469 ± 426/μL, CRP 2.81 ± 0.56 mg/dL. Lower lymphocyte counts (P = 0.002) and higher CRP levels (P = 0.019) were found in patients with influenza comparing them with pneumonia caused by other viruses.ConclusionsIn our study, children with positive influenza pneumonia showed lower levels of lymphocytes and higher levels of CRP compared with negative influenza. Lower lymphocyte counts and high CRP levels have been found in influenza-positive patients mainly in adult studies. In children with suspected influenza pneumonia, lower lymphocyte counts and higher CRP levels can aid clinical diagnosis before molecular confirmation in influenza pneumonia.

C reactive protein elevation among children or among mothers\u2019 of children with autism during pregnancy, a review and meta-analysis

ObjectiveTo evaluate if children with ASD, or mothers of ASD children have elevated CRP during pregnancy.BackgroundAutism spectrum disorder (ASD) is a neuro developmental disorder with incidence of 1 in 68 children occur in all racial, ethnic, and socioeconomic groups. Economic burden between $11.5 billion - $60.9 billion and family average medical expenditures of $4110–$6200 per year. Conflicting evidence exist about role of maternal CRP during pregnancy with ASD child.MethodsSearches on database; Pubmed, Medline, Embase and google scholar using key words; C reactive protein (CRP), Maternal CRP, ASD, autism, autistic disorder, Inflammation. All English-language studies published between 1960 and 2019 pertaining to CRP and ASD. All Studies which provided data on CRP levels during pregnancy (mCRP) of Mothers of offsprings with ASD and (mCRP) of mothers of normal subjects were selected. Data were extracted in the form of odd ratios of having high mCRP in mothers of children with ASD versus mCRP of mothers of normal controls. Since these odd ratios were adjusted, therefore no Meta regression were attempted. Significant heterogeneity was found; therefore, random effect model was employed.ResultsReview of CRP levels in children with ASD showed higher level in children with ASD than control, although different methodology and absence of numerical data did not allow metanalysis. Regarding mCRP and ASD, three studies were identified that provide data on mCRP and ASD. Four datasets were created from these 3 studies as the study by Zerbo et al. provided data in 2 subsets. Total number of subjects were 5258 (Brown, N = 677, Zerbo = 416, Koks = 4165) extracted data from these studies was pooled for analysis. Random effect model was employed and substantial heterogeneity among the studies was observed 11. Mothers of children with ASD have adjusted Odd ratio of 1.02 (0.948 to 1.103, I2 = 75, P = 0.558) to have high mCRP comparing mothers of control.ConclusionMothers of children with ASD appear not to have elevated CRP during pregnancy. Children with ASD appear to have higher levels of CRP levels.

Prognostic Value of Serum Fibrinogen Level in Determining the Severity of Appendicitis Inflammation in Adult and Pediatric Patients Undergoing Appendectomy in Two Local Centres in Tehran

Background: Despite the recent advancements, negative appendectomy cases are notable, especially in children. We evaluated the prognostic value of serum fibrinogen level for the prediction of the severity of acute appendicitis.&#x0D; Methods: A cross-sectional study of children and adults who had undergone appendectomy at Ali Asghar and Rasool-e Akram hospitals, Iran, was performed. Before surgery, serum fibrinogen level was assessed by using the Clauss technique. Finally, serum fibrinogen was compared between the two groups of complicated acute appendicitis and uncomplicated ones.&#x0D; Results: In the adult's complicated and uncomplicated appendicitis, no significant differences were noted in gender distribution, WBC count, and segment levels. Serum fibrinogen and C-reactive protein levels in children with complicated appendicitis were significantly higher than those in the uncomplicated ones. Serum fibrinogen level of 450 mg/dl was the optimum cut-off for predicting the severity of appendicitis in children. Serum fibrinogen level in adults with the complicated appendicitis was significantly higher than the uncomplicated appendicitis group. Also, 530 mg/dl was found the best serum fibrinogen cut-off to predict the severity of appendicitis in adults.&#x0D; Conclusion: Serum fibrinogen level is an appropriate diagnostic marker for the distinction of acute complicated appendicitis from uncomplicated appendicitis in children and adults.

C-reactive protein levels in children with uncomplicated malaria

Background: Malaria is one of the biggest burden in terms of morbidity and mortality among all infectious diseases and continues to be a major health problem in India. The objective of this study was to study the levels of C-reactive protein in children with uncomplicated Malaria. To correlate C-reactive protein levels with malaria parasite density and species of Malaria.Methods: Retrospective study was done in Father Muller Medical College, Mangalore, Karnataka. 50 patients below 15 years of age malaria parasite positive by fluorescent test (MPFT) and by Peripheral smear formed the subjects and CRP levels and parasite densities was noted down into the proforma.Results: The age group predominantly was children more than 10 years. Plasmodium vivax was the type of malaria in 60% children. Most common symptoms were fever (100%), chills and rigors (41%), vomiting (48%) and headache (24%). Clinical signs observed were hepatomegaly (30%) and splenomegaly (64%). Mean levels of C reactive protein (CRP) were 42.91%with standard deviation of 31.62. Mean CRP levels were high in children with Falciparum malaria (44.51±34.19).58% had CRP levels ranging from 6-50 mg/l. 50% children with CRP levels &gt;50 mg/L had parasite density of (++++) which is 100 parasites per 1 field of quantitative buffy coat.Conclusions: C-reactive protein levels are markedly elevated in acute malarial infection in paediatric age group.It correlates well with disease severity.

C-reactive protein levels in girls with lower urinary tract symptoms

Daytime lower urinary tract (LUT) conditions are identified as daytime incontinence problems for children in whom any cause of neuropathy and uropathy has been excluded. C-reactive protein (CRP) is a common marker of acute or chronic inflammation and infection. Increased CRP levels have been detected in the studies conducted on adults diagnosed with overactive bladders and interstitial cystitis. This study aimed to investigate the role of serum CRP levels in girls suffering from daytime LUT conditions. Out of the 752 patients who presented to the outpatient clinics with lower urinary tract symptoms, 709 were excluded due to: being boys, having previous urinary tract surgery, an active urinary tract infection, a neurological anomaly, a urinary system anomaly, having rheumatic disease, any chronic disease, any febrile infection over the past week, a history of constipation, and enuresis nocturna. Forty-three girls with LUT conditions and aged 8-10 years were included in the study as the patient group. Forty girls who attended the urology outpatient clinic without LUT conditions, or active urinary tract infections and any chronic disease requiring follow-up constituted the control group. Under the control of the parents, all subjects were asked to fill out 3-day voiding diaries. The voiding diaries identified frequency, urgency, urgency urinary incontinence, and functional bladder capacity data. All subjects also completed a dysfunctional voiding scoring system (DVSS). The serum CRP levels of all subjects were measured. There was a significant difference in serum CRP levels and DVSS between the patient group and the control group (P = 0.001, P = 0.001). The mean serum CRP levels showed a significant increase when frequency and urgency scores were ≥8, the urge incontinence score was ≥2 and the DVS score DVSS was ≥14 in the voiding diaries of the patient group (Table). Lower urinary tract dysfunction is defined as a condition involving abnormalities of filling and/or emptying of the bladder. This frequently encountered problem constitutes >40% of all pediatric urology outpatient visits. The relationship between LUT conditions and serum CRP in both genders has been detected. However, it is believed that to our knowledge, this is the first study looking at the relationship between daytime LUTS and increased CRP levels in children. The most important limitations of the study were: having a small number of patients, and the sample consisting of only one gender and a specific age group. The serum CRP levels were significantly higher in the girls with daytime LUT conditions than in the control group. Also, the CRP levels significantly increased as DVSS, frequency, urgency, and urge incontinence scores increased.

Disease indicators for sepsis and analysis of sepsis treatment in children using the continuous blood purification technique.

We analyzed disease severity, inflammation markers, and dynamic changes in cartilage glycoprotein 39 (YKL-40) and C-reactive protein (CRP) levels in children with sepsis before and after treatment with continuous blood purification (CBP). Study participants were 30 children with severe sepsis who were cured from the disease (experimental group) in the Children's Serious Disease Center of In-ner Mongolia People's Hospital between June 2012 and October 2013. Symptomatic CBP treatment was performed after disease severity scoring. Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), YKL-40, and CRP levels were tested 0, 12, 24, and 48 h after CBP treatment. YKL-40 mRNA expression in whole blood was determined biochemically, and its expression in peripheral blood was determined with an immunochemical method. We found a significant difference in disease severity scores before and 48 h after CBP treatment (P < 0.05). IL-6, TNF-α, YKL-40, and CRP levels in children with sepsis at 12, 24, and 48 h after CBP treatment significantly differed from those before treatment (P < 0.05). The relative expression of YKL-40 mRNA in the experimental group before CBP treatment significantly increased from that of the control group (P < 0.05). We found a positive correlation between IL-6, TNF-α, YKL-40, and CRP levels 48 h after CBP treatment. In conclusion, CBP is an effective treatment strategy for pediatric sepsis. YKL-40 and CRP can be used to evaluate the effects of sepsis treatment.

Elevated Plasma B-type Natriuretic Peptide and C-reactive Protein Levels in Children with Restrictive Right Ventricular Physiology Following Tetralogy of Fallot Repair

This study aimed to compare the levels of plasma B-type natriuretic peptide (BNP) and C-reactive protein (CRP) in relation to oxygen transport between patients with restrictive right ventricle (rRV) and those without (non-rRV) early after tetralogy of Fallot (TOF) repair. Eighty patients (30 in the rRV group) underwent TOF repair in 2011 and 2012. BNP and CRP were repeatedly measured during postoperative day (POD) 7, along with oxygen transport variables including arterial and superior vena cava oxygen saturation (SaO2 and SvO2 ), oxygen extraction ratio (ERO2 ), and lactate. Demographic data included age and durations of cardiopulmonary bypass (CPB), aortic cross-clamping (ACC), mechanical ventilation, and ICU and hospital stays. During POD 7, BNP did not change in either of the two groups but was consistently higher in the rRV group (P < .0001). CRP increased from POD 1 to POD 2 and decreased thereafter. The decrease was slower in the rRV group (P = .04). The increase in SvO2 and the decrease in ERO2 were slower in the rRV group (P < .05). Lactate decreased in both groups (P < .05) but was consistently higher in the rRV group (P = .03). BNP was negatively correlated with SvO2 and preoperative SaO2 and positively correlated with ERO2 and lactate (P < .05). No correlation was found between CRP and oxygen transport variables. The rRV group was older and required longer CPB, ACC, mechanical ventilation, and ICU and hospital stays compared with the non-rRV group (P < .05 for all). rRV physiology is associated with significantly higher BNP and CRP levels with poorer balance of systemic oxygen transport. Information about these pathophysiological changes may help to identify appropriate treatment strategies in this difficult group of patients.

The evaluation of serum N-terminal prohormone brain-type natriuretic peptide, troponin-I, and high-sensitivity C-reactive protein levels in children with congenital heart disease

Although advanced diagnostic and treatment methods are available, congenital heart disease (CHD) holds an important place among the causes of death within the first year of age. Therefore, several prognostic factors are needed for diagnosis and monitoring of these patients. In this study, which includes 66 CHD patients and 38 healthy control children, serum cardiac troponin-I (cTnI), high-sensitivity C-reactive protein (Hs-CRP), and N-terminal prohormone brain-type natriuretic peptide (NT-proBNP) levels were analyzed for their prognostics values. The patient groups were categorized and then evaluated as cyanotic (n = 16), acyanotic (n = 50), symptomatic (n = 23), asymptomatic (n = 43), and isolated ventricular septal defect (VSD)-isolated atrial septal defect (ASD) groups. Cyanotic group was statistically compared with acyanotic group, symptomatic group with asymptomatic group, and VSD group with ASD group. Between the cyanotic, acyanotic, and control groups; between symptomatic and asymptomatic groups; and between the VSD and ASD groups, significant difference was not showed for age (p > 0.05). NT-proBNP was found to be significantly higher in the cyanotic group than acyanotic and control group, in the symptomatic group than asymptomatic group; and in the patient group than healthy control group (p < 0.05). Between the groups of VSD and ASD, significant difference was not showed (p > 0.05). The same comparison results for TnI and Hs-CRP were not significant (p > 0.05). TnI and Hs-CRP were only found significantly higher in the patient group than healthy control group (p < 0.05). Eventually, we think that NT-proBNP, Hs-CRP, and TnI might be used for clinical management and estimation of outcome of these disorders in the future and these also might be able to modify existing strategies, but much more studies are needed.

C-reactive protein level in children with Kawasaki disease unresponsive to initial intravenous immunoglobulin therapy

Objective To analyze the serum C reactive protein (CRP) level in children with Kawasaki disease (KD) during the treatment with intravenous immunoglobulin (IVIG).Methods The study objects were collected from January 2009 to December 2012 in the two women and children hospitals.All the patients received IVIG of 2 g/kg daily.The children afebrile in 48 hours after initial administration of IVIG were defined as group A.The febrile children were given second IVIG.Patients who were afebrile in 48 hours after second IVIG were defined as group B.The rest was assigned to group C.CRP levels were detected before initial IVIG and 48 hours after initial IVIG in all the children.Then the data were analyzed statistically.Results 146 children were enrolled and 84 were male and 62 were female.Group A had 110 children with 8 developing CALs (7.3％),group B had 26 children with 5 CALs (19.2％),group C had 10 with 7 CALs (70％).There was significant difference in CRP level 48 hours after initial IVIG between the CALs and the negative children but no difference before initial IVIG.There were no significant differences in both CRP level and CALs between each group pairs before initial IVIG.48 hours after administration of initial IVIG,there were significant differences in both CRP level and CALs among groups A,B,and C.It showed that there was correlation between CRP level and the development of CALs.Conclusions Patients unresponsive to IVIG are liable to develop CALs.Patients with high CRP level 48 hours after initial IVIG are liable to develop to CALs as well.The patients who are the non-responder with high CRP are likely to fail in the additional IVIG treatment.These patients may need other powerful anti-inflammation therapy earlier. Key words: Kawasaki disease; C reactive protein; Intravenous immunoglobulin; Children

Effect of adenotonsillectomy on c-reactive protein levels in children with obstructive sleep apnea: A meta-analysis

Children with obstructive sleep apnea syndrome (OSAS) have increased systemic inflammation, as assessed by c-reactive protein (CRP), and are at risk for substantial end-organ damage. Previous studies assessing the effect of adenotonsillectomy (T&A) on CRP in children with OSAS have yielded conflicting results. Therefore, the purpose of the current investigation was to perform a meta-analysis of the effect of T&A on CRP in children with OSAS and explore possible moderating factors. Multiple databases (PubMed, CINAHL, and Cochrane) were searched for relevant studies. Effective size was calculated with standardized mean differences (SMD) and analyzed with random-effects model. Moderators were examined with mixed-effects models. Overall, T&A significantly reduced CRP (SMD=-0.79, 95% CI -1.33 to -0.25). We found significant between-study heterogeneity (Cochran's Q=54.6, df=7, p<0.001; I2=90.7%, 95% CI 77.5-98.2%; and H2=10.7, 95% CI 4.5-55.7). We did not find evidence of publication bias or significant effects of tested moderators (study year, study size, age, gender, obesity, apnea-hypopnea index, oxygen nadir, pre-surgical CRP, follow-up duration). The results of the current study indicate that T&A significantly reduces CRP levels in children with OSAS. Despite the presence of significant between-study heterogeneity, we did not identify any significant moderating factors.

Zinc, Copper and C-reactive Protein in Children with Severe Plasmodium falciparum Malaria in an Area of Unstable Malaria Transmission in Eastern Sudan

Few data exist on the role of trace element in the pathogenesis of severe malaria. The study was conducted at Kassala Hospital, eastern Sudan, to investigate the role of zinc, copper and C-reactive protein levels in children with severe Plasmodium falciparum malaria. Zinc, copper and C-reactive protein levels were measured in sera of three groups of children (35 in each arm): those with severe malaria, those with uncomplicated P. falciparum malaria and healthy controls. Although the zinc levels were significantly lower, the levels of copper and C-reactive protein were significantly higher in patients with severe P. falciparum. There was a significant inverse correlation between zinc and C-reactive protein and significant positive correlation between copper and C-reactive protein. The change in zinc and copper may play a role in pathogenesis of P. falciparum malaria.

Impact of C-reactive protein test results on evidence-based decision-making in cases of bacterial infection

BackgroundC-reactive protein (CRP) is widely used to detect bacterial infection in children. We investigated the impact of CRP test results on decision-making and summarized the evidence base (EB) of CRP testing.MethodsWe collected information from the hospital records of 91 neonates with suspected sepsis and of 152 febrile children with suspected infection on the number of ordered CRP tests, the number of EB-CRP tests, and the impact of the test results on decision-making. CRP diagnostic accuracy studies focusing on pediatric infections were reviewed critically. The main outcomes were the proportion of CRP tests that were EB and the proportion of tests that affected decision-making. A secondary outcome was the overall one-year expenditure on CRP testing.ResultsThe current EB for CRP testing in pediatric infections is weak and suggests that CRP is of low diagnostic value. Approximately 54.8% of tests performed for suspected neonatal sepsis and 28% of tests performed for other infections were EB; however, the results of only 12.9% of neonatal sepsis tests and of 29.9% of tests on children with other infections informed decision-making. The one-year overall cost for CRP testing and related health care was $26,715.9.ConclusionsThe routine ordering of CRP for children with infections is based on weak evidence. The impact of the CRP test results on decision-making is rather small, and CRP ordering may contribute to unnecessary health care expenditures. Better quality research is needed to definitively determine the diagnostic accuracy of CRP levels in children with infections.