C-Reactive Protein Diagnostic Value for Bacterial Infections

IF 1.6 4区 医学 Q2 PEDIATRICS
Hinpetch Daungsupawong, Viroj Wiwanitkit
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Furthermore, the lack of microbiological confirmation of bacterial illnesses, along with the reliance on clinical diagnosis rather than laboratory-confirmation, limits the accuracy of findings regarding CRP's diagnostic value. Although the link between CRP and clinical symptoms like fever and leukocytosis is useful, the study should assess other potential factors that could influence CRP levels, such as underlying disease, antibiotic use history, and vaccine history. The omission of these factors is a notable limitation, as their inclusion could have improved the ability of CRP to distinguish severe illness and provided more comprehensive insights into its diagnostic value.</p><p>The sensitivity and specificity data offered highlighted critical difficulties. CRP has moderate specificity (about 60%) for bacterial infections at thresholds of 2 mg/dL and above, but low sensitivity, particularly at high thresholds (e.g., &lt; 50%at CRP ≥ 5 mg/dL). This shows that CRP alone may not be a valid independent biomarker for identifying bacterial infections in children, emphasising the importance of additional diagnostic techniques. Although this study successfully shows a link between CRP levels and demographic characteristics such as age, it fails to investigate the role of these variables in more depth. For example, younger children frequently have different reactions to CRP than older children and adults, and this age-related variance must be better understood. Stratifying patients based on age and other pertinent characteristics may improve CRP's diagnostic usefulness.</p><p>Looking to this work raises several key questions that could inform future research. 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引用次数: 0

Abstract

Dear Editor,

we hereby comment on the publication on “C-reactive protein diagnostic value for bacterial infections in the paediatric emergency department setting” [1] This study sheds light on the association between CRP levels and bacterial infections in a paediatric emergency room (PER). A retrospective cohort method is excellent for analysing big data sets and identifying patterns in CRP levels across clinical outcomes. However, greater information about the many types of bacterial infections implicated would have been beneficial to this study. Because CRP responses vary widely depending on the causal infection, data disaggregation by bacterial species may improve the findings' interpretability. Furthermore, the lack of microbiological confirmation of bacterial illnesses, along with the reliance on clinical diagnosis rather than laboratory-confirmation, limits the accuracy of findings regarding CRP's diagnostic value. Although the link between CRP and clinical symptoms like fever and leukocytosis is useful, the study should assess other potential factors that could influence CRP levels, such as underlying disease, antibiotic use history, and vaccine history. The omission of these factors is a notable limitation, as their inclusion could have improved the ability of CRP to distinguish severe illness and provided more comprehensive insights into its diagnostic value.

The sensitivity and specificity data offered highlighted critical difficulties. CRP has moderate specificity (about 60%) for bacterial infections at thresholds of 2 mg/dL and above, but low sensitivity, particularly at high thresholds (e.g., < 50%at CRP ≥ 5 mg/dL). This shows that CRP alone may not be a valid independent biomarker for identifying bacterial infections in children, emphasising the importance of additional diagnostic techniques. Although this study successfully shows a link between CRP levels and demographic characteristics such as age, it fails to investigate the role of these variables in more depth. For example, younger children frequently have different reactions to CRP than older children and adults, and this age-related variance must be better understood. Stratifying patients based on age and other pertinent characteristics may improve CRP's diagnostic usefulness.

Looking to this work raises several key questions that could inform future research. First, how can CRP be incorporated into diagnostic algorithms for bacterial infections in paediatric crises, particularly when paired with other biomarkers such as procalcitonin (PCT) and clinical observations [2], and what function does CRP play in early detection of infection? According to the literature [2], multi-panel diagnostic markers, which include PCT, is proposed to provide improved diagnostic properties. According to systematic review, both indicators are beneficial in directing antibiotic therapy, with PCT demonstrating a more dynamic response to treatment [3]. Second, the link between lower CRP levels and younger age warrants more examination. How do age-specific thresholds influence diagnostic accuracy? If reference ranges are set for each child, and gender and ethnicity are not associated with CRP levels, may these characteristics still play an unacknowledged role in the inflammatory response? Further research should look into potential biological or environmental factors that could influence CRP levels in various paediatric populations.

In the future, there are numerous opportunities for future study. A promising approach is to combine CRP with molecular diagnostic tools like PCR. This enables more exact identification of bacterial pathogens and correlates CRP levels with infection severity. Multi-biomarker panels that combine CRP with additional indicators, such as PCT, have the potential to improve diagnostic sensitivity and specificity, allowing doctors to distinguish viral and bacterial infections more effectively. Longitudinal studies that track CRP levels over time may shed light on the significance of CRP in monitoring illness progression and response to treatment, particularly in paediatric populations. Finally, large prospective cohort studies involving varied geographic and demographic groupings will provide a better understanding of CRP's diagnostic usefulness and enable the establishment of age- and context-specific CRP thresholds. These techniques have the potential to strengthen the overall diagnostic framework for paediatric infectious illnesses, improve clinical outcomes, and make better use of healthcare resources.

H.D.: ideas, writing, analysis, approval. V.W.: ideas, supervision, approval.

The authors use a language editing computational tool in preparation of the article.

The authors declare no conflicts of interest.

c -反应蛋白对细菌感染的诊断价值。
尊敬的编辑,我们在此对《c反应蛋白在儿科急诊科环境中对细菌感染的诊断价值》发表评论[1]本研究阐明了儿科急诊室(PER) CRP水平与细菌感染之间的关系。回顾性队列方法在分析大数据集和识别临床结果中CRP水平的模式方面非常出色。然而,更多关于多种细菌感染的信息对这项研究是有益的。由于c反应蛋白的反应因感染的原因而有很大差异,按细菌种类分类的数据可能会提高研究结果的可解释性。此外,缺乏细菌性疾病的微生物学证实,以及对临床诊断的依赖而不是实验室确认,限制了CRP诊断价值的准确性。虽然CRP与临床症状(如发烧和白细胞增多)之间的联系是有用的,但研究应评估其他可能影响CRP水平的潜在因素,如潜在疾病、抗生素使用史和疫苗史。这些因素的遗漏是一个明显的限制,因为它们的纳入可以提高CRP区分严重疾病的能力,并为其诊断价值提供更全面的见解。敏感性和特异性数据提供了突出的关键困难。当阈值为2mg /dL及以上时,CRP对细菌感染具有中等特异性(约60%),但敏感性较低,特别是在高阈值时(例如,当CRP≥5mg /dL时,敏感性为50%)。这表明单独的CRP可能不是识别儿童细菌感染的有效的独立生物标志物,强调了其他诊断技术的重要性。尽管这项研究成功地显示了CRP水平与人口统计学特征(如年龄)之间的联系,但它未能更深入地研究这些变量的作用。例如,年幼的儿童对CRP的反应通常与年长的儿童和成人不同,必须更好地了解这种与年龄相关的差异。根据年龄和其他相关特征对患者进行分层可以提高CRP的诊断价值。这项工作提出了几个关键问题,可以为未来的研究提供信息。首先,如何将CRP纳入儿科危重期细菌感染的诊断算法,特别是当与其他生物标志物如降钙素原(PCT)和临床观察[2]配对时,CRP在早期感染检测中发挥什么功能?根据文献[2],包括PCT在内的多面板诊断标记物被提出以提供改进的诊断特性。根据系统综述,这两个指标都有利于指导抗生素治疗,其中PCT对治疗表现出更动态的反应。其次,较低的CRP水平和较年轻的年龄之间的联系值得更多的研究。年龄特异性阈值如何影响诊断准确性?如果为每个孩子设定了参考范围,并且性别和种族与CRP水平无关,那么这些特征是否仍然在炎症反应中起着未被承认的作用?进一步的研究应该着眼于可能影响不同儿科人群CRP水平的潜在生物或环境因素。在未来,未来的学习机会很多。一种很有前景的方法是将CRP与PCR等分子诊断工具结合起来。这可以更准确地识别细菌病原体,并将CRP水平与感染严重程度联系起来。将CRP与其他指标(如PCT)相结合的多生物标志物组有可能提高诊断的敏感性和特异性,使医生能够更有效地区分病毒和细菌感染。长期跟踪CRP水平的纵向研究可能揭示CRP在监测疾病进展和治疗反应方面的重要性,特别是在儿科人群中。最后,涉及不同地理和人口统计学分组的大型前瞻性队列研究将更好地了解CRP的诊断用途,并能够建立年龄和特定环境的CRP阈值。这些技术有可能加强儿科传染病的总体诊断框架,改善临床结果,并更好地利用卫生保健资源。想法,写作,分析,批准。想法,监督,批准。作者在准备文章时使用了一种语言编辑计算工具。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
5.90%
发文量
487
审稿时长
3-6 weeks
期刊介绍: The Journal of Paediatrics and Child Health publishes original research articles of scientific excellence in paediatrics and child health. Research Articles, Case Reports and Letters to the Editor are published, together with invited Reviews, Annotations, Editorial Comments and manuscripts of educational interest.
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