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Clin Infect Dis. 2017 Jun 15;64(suppl_3):S378-S386. doi: 10.1093/cid/cix150.

Association of C-Reactive Protein With Bacterial and Respiratory Syncytial Virus-Associated Pneumonia Among Children Aged <5 Years in the PERCH Study.

Author information

1
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, and.
2
Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore.
3
Department of Pathology, University of Otago, and.
4
Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.
5
Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi.
6
Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
7
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab.
8
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
9
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
10
Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
11
Medical Research Council Unit, Basse, The Gambia.
12
Department of Paediatrics, University of Auckland, and.
13
Centre for International Health, University of Otago, Dunedin, New Zealand.
14
Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore.
15
Bill & Melinda Gates Foundation, Seattle, Washington.
16
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.
17
Center for Global Health and Development, Boston University School of Public Health, Massachusetts.
18
Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and.
19
Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.
20
Nakhon Phanom Provincial Hospital, Thailand.
21
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
22
Department of Clinical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands.
23
Fondation Mérieux, Lyon, France ; Departments of.
24
Mental Health and.
25
International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
26
Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa.
27
Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, District of Columbia.
28
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka.
29
Medical Microbiology Department, Lagos University Teaching Hospital, Nigeria.
30
Department of Emergency Medicine, University of New Mexico, Albuquerque.
31
Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka.
32
Centre pour le Développement des Vaccins (CVD-Mali), Bamako; and.
33
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Abstract

Background.:

Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study.

Methods.:

We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases.

Results.:

Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIV-negative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity.

Conclusions.:

Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.

KEYWORDS:

C-reactive protein; RSV; bacteria; biomarker; pneumonia.

PMID:
28575375
PMCID:
PMC5447856
DOI:
10.1093/cid/cix150
[Indexed for MEDLINE]
Free PMC Article

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