The Prognostic Value of C-Reactive Protein For Children With Pneumonia

Background: Pneumonia is a leading cause of hospitalization in children. Previous studies on CRP in the context of pneumonia have focused on the ability of CRP measurement to differentiate between bacterial and viral pathogens, yet evidence remains conflicting. The aim of the current study was to measure the prognostic value of CRP and its ability to predict pneumonia-associated complications.

Methods: A 3.75-years retrospective cohort analysis of all pediatric emergency department visits with a discharge diagnosis of pneumonia. Visits where CRP was not measured or with a discharge-diagnosis of viral pneumonia were excluded. The following four outcomes were studied: (1) hospitalization, (2) presence of parapneumonic effusion (PPE), (3) placement of a chest-drain, and (4) admission to PICU. A multivariate model to predict these outcomes was constructed and validated using k-fold cross-validation, highlighting the value of CRP within these models.

Results: During the study time period there were 2,561 visits for pneumonia, of which 810 were included in our analysis. The mean age was 4.8 years (range 0.2-17.7). Overall, 38.8% visits ended in hospitalization, 2.2% required admission to PICU, 15.2% complicated by a PPE of which 28% required the placement of a chest-drain. Statistically significant association was found between CRP levels and each of these outcomes (p < 0.001). Incorporating CRP within a multivariate prediction model provided an AUC of up to 0.96.

Conclusions: CRP can be a useful prognostic marker when evaluating a patient with pneumonia and could help the pediatrician in identifying patients needing closer follow up.