Document Type
Journal Article
Publication Date
6-15-2017
Journal
Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America
Volume
64
Issue
suppl_3
Inclusive Pages
S378-386
DOI
10.1093/cid/cix150
Abstract
Background.
Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods.
We measured serum CRP levels in cases with World Health Organization–defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for “confirmed” bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to “RSV pneumonia” (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results.
Among 601 human immunodeficiency virus (HIV)–negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIV-negative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions.
Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
APA Citation
Higdon, M., Le, T., O'Brien, K., Murdoch, D., Prosperi, C., Baggett, H., Park, D., & +several additional authors (2017). Association of C-Reactive Protein With Bacterial and Respiratory Syncytial Virus-Associated Pneumonia Among Children Aged <5 Years in the PERCH>Study.. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 64 (suppl_3). http://dx.doi.org/10.1093/cid/cix150
Peer Reviewed
1
Open Access
1
Comments
Reproduced with permission of Oxford University Press. Clinical Infectious Diseases