{"title":"C-Reactive Protein Diagnostic Value for Bacterial Infections","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1111/jpc.70059","DOIUrl":null,"url":null,"abstract":"<p>Dear Editor,</p><p>we hereby comment on the publication on “C-reactive protein diagnostic value for bacterial infections in the paediatric emergency department setting” [<span>1</span>] 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.</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., < 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. 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 [<span>2</span>], and what function does CRP play in early detection of infection? According to the literature [<span>2</span>], 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 [<span>3</span>]. 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.</p><p>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.</p><p>\n <b>H.D.:</b> ideas, writing, analysis, approval. <b>V.W.:</b> ideas, supervision, approval.</p><p>The authors use a language editing computational tool in preparation of the article.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 6","pages":"998-999"},"PeriodicalIF":1.6000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.70059","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of paediatrics and child health","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jpc.70059","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
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.
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.