Objective: To evaluate the implications of extremely elevated CRP levels in hospitalized children.
Background: C-reactive protein (CRP) is a plasma protein, widely used as a marker for infection and inflammation, as part of the acute phase reactant response. The significance of extremely elevated CRP levels was studied in the adult population, revealing striking implications. The significance of very high CRP levels was not as yet studied in the pediatric population.
Methods: We analyzed the electronic records of all patients admitted at Schneider Medical Center between January 2010 andDecember 2013 with CRP level above 30 mg/dl. Data included patient demographics, admission details, background conditions, main diagnoses, other laboratory parameters (leukocyte and neutrophil counts, platelets, albumin and phosphorus), microbiology studies and clinical outcome.
Results: Extremely elevated CRP levels were measured in 435 patients (0.72%)of all admissions. Mortality rate (8.5%) and mean hospital stay (15.2 days) of the study group were significantly higher than the means in all hospitalized children (p<0.01)). The most common diagnosis was pneumonia (46.6%), often with empyema (42.8%). No statistically significant correlations were found between CRP levels and other inflammatory markers. However, higher CRP levels were correlated with low albumin levels (p<0.01). In the sub-group of oncologic patients, 45.9% had bacteremia with a crude mortality rate of 17.6%.
Conclusions: CRP>30 mg/dl carries an unfavorable clinical outcome, including striking mortality rates, specifically in oncologic patients. Infectious diseases, mainly bacterial infections, arethe main etiologies; in previously healthy children, pneumonia is the most common diagnosis (65.4%).
