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Predicting Outcome of Childhood Bacterial Meningitis With a Single Measurement of C-Reactive Protein

Peltola, Heikki MD; Pelkonen, Tuula MD; Roine, Irmeli MD; Cruzeiro, Manuel Leite MD; Bernardino, Luis MDand the Latin American Meningitis Study Group

The Pediatric Infectious Disease Journal: June 2016 - Volume 35 - Issue 6 - p 617–621
doi: 10.1097/INF.0000000000001133
Original Studies

Introduction: C-reactive protein (CRP), a marker of inflammation, shows high serum levels in invasive bacterial infections. We investigated the potential of a single CRP measurement at different phases of acute childhood bacterial meningitis to predict outcomes.

Methods: Using whole-blood finger-prick samples with no centrifugation, CRP was measured quantitatively on arrival and on day 3 or 4 in children participating in 2 prospective, randomized, double-blind treatment studies conducted in Latin America or Angola. The results were compared with patient outcomes.

Results: Although initial CRP values from 669 children gave useful prognostic information, the 3rd or 4th day measurements taken from 275 children associated significantly with seizures, slow recovery and low scores on the Glasgow Outcome Scale, with odds ratios for CRP values above the median (62 mg/L) ranging from 2 to 6, 2 to 5, and 3 to 5 (Latin America–Angola), respectively. Hearing impairment, although not full deafness, was 3 to 7 times more likely if CRP was above the median soon after hospitalization.

Conclusions: Especially in resource-poor settings, clinicians have few simple-enough tools to identify the child with meningitis who requires maximum attention. CRP is a worthy addition.

Supplemental Digital Content is available in the text.

From the *Children’s Hospital, Helsinki University Hospital, Helsinki, Finland; Faculty of Medicine, University of Helsinki, Helsinki, Finland; Infectious Diseases, David Bernardino Children’s Hospital, Luanda, Angola; and §Faculty of Medicine, University Diego Portales, Santiago, Chile.

Accepted for publication November 25, 2015.

The Sigrid Jusélius Foundation and the Foundation for Paediatric Research of Finland partially funded the study. Orion Diagnostica, Espoo, Finland, provided the CRP analyzers (Quikread), reagents, and open-access fee but had no access to the results and played no role in the interpretation of the results.

I. Roine is one of the owners of a Chilean company that distributes laboratory reagents and equipment, including CRP reagents and the Quikread instrument. The author have no other conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Tuula Pelkonen, MD, Tammitie 20 A 11, 00330 Helsinki, Finland. E-mail: tuulapelkonen@hotmail.com.

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