FROM THE PEDIATRIC INFECTIOUS DISEASE JOURNAL
Measuring C-reactive protein (CRP) levels in children with bacterial meningitis can help determine those children’s prognoses, a study showed.
“A single CRP measurement on the 3rd or 4th day is the most informative, since it rather reliably identifies the patients with highest risk of seizures, slow recovery, hearing impairment, and low scoring in the Glasgow Outcome Scale,” wrote Dr. Heikki Peltola of Children’s Hospital and Helsinki University Hospital, both in Helsinki, and his associates. CRP determination is the fastest, simplest, cheapest, easiest yardstick to use for predicting outcomes in resource-poor settings, the authors said.
“The predictive capacity of CRP almost paralleled the child’s score on the Glasgow Coma Scale at presentation to hospital,” the authors wrote, and combining the two doubled the prognostic predictive power. They reported their findings online in the Pediatric Infectious Disease Journal ( 2016 Mar 15. doi: 10.1097/INF.0000000000001133 ).
The researchers measured CRP levels in fingerprick blood samples from 669 children on their 1st through 4th days after hospitalization for bacterial meningitis. The children were all participating in two separate prospective, randomized double-blind treatment studies. One trial, conducted in Argentina, Brazil, the Dominican Republic, Ecuador, Paraguay, and Venezuela, involved 654 children, aged 2 months to 16 years, who received ceftriaxone and either dexamethasone or oral glycerol, both, or neither. The other trial, in Luanda, Angola, included 723 children, aged 2 months to 13 years, who received cefotaxime either as a slow continuous infusion or in 6-hourly boluses for 24 hours, and either acetaminophen or placebo.
CRP levels from day 1 or 2 were a median 159 mg/L among 285 Latin American children and a median 161 mg/L among 384 Angolan children. Though no correlation existed between CRP levels and the children’s age or sex, children with meningococcal meningitis had the highest and lowest levels. Higher levels were associated with lower cerebrospinal fluid glucose concentrations.
Levels from day 3 or 4 were a median 62 mg/L among 218 Latin American children and 117 mg/L among 57 Angolan children. The Latin American children with CRP levels above 62 mg/L had 2.4 times greater odds of seizures, 2.3 times greater odds of a secondary fever, 2.1 times greater odds of a suboptimal clinical course, 3.4 times greater odds of any neurological sequelae, 2.9 times greater odds of any hearing impairment, and 3.1 times greater odds of a Glasgow Outcome Scale score below 5.
The Angolan children with CRP levels above 62 mg/L had 6 times greater odds of a Glasgow Coma score below 15 for 2 days, 9 times greater odds of a hospital stay longer than 8 days, 6.3 times greater odds of seizures, 5.1 times greater odds of a suboptimal clinical course, and 7 times greater odds of any hearing impairment.
“When the child showed both a CRP above median level and a Glasgow Coma score below 13, the odds for severe neurological sequelae, any neurological sequelae, or any hearing impairment increased to 25.4, 7.9, and 5.3, respectively,” the authors wrote. “Full deafness by itself was not predicted by either index.”
The research was funded by the Sigrid Jusélius Foundation and the Foundation for Paediatric Research of Finland. CRP analyzers were provided by Orion Diagnostica. Dr. Irmeli Roine owns a Chilean company that distributes laboratory equipment, including CRP reagents and the QuikRead instrument. No other authors reported disclosures.