Diagnostic of C-Reactive Protein in Febrile Children

The measurement of C-reactive protein (CRP), an acute-phase protein synthesized by hepatocytes, is valuable to distinguish bacterial infection from non-bacterial infections in children. The aim of this study is to know the diagnostic properties of quantitative CRP associated with clinically bacterial and non-bacterial infection in febrile children. Febrile children which was studied were presenting in the Paediatric Emergency Department, their ages were up to 12 years, with axillary’s temperature ≥38.5°C, and the clinically undetectable source of fever were enrolled in this consecutive study from September, 2009, up to August, 2010. Informed consent was obtained for the use of CRP evaluation. The CRP concentration was measured with immunoturbidimetry method (Pure auto S CRP latex (SS-type), Sekisui Medical Co., Ltd) and an auto photometer TMS 1024i. The main outcome result was the presence of the laboratory examination results, blood culture, or radio graphically. The receiver operator characteristic (ROC) curve was modelled for quantitative CRP to identify the optimal test value. Eighty-six patients were enrolled in this study. Forty-one (47.6%) had bacterial infection and 45 (52.3%) had non-bacterial infection. The CRP concentration was significantly different between the two groups (p=0.003). The ROC analysis demonstrated an area under curve (AUC) 0.689, standard error (SE) 0.059, and 95% confidence interval (CI) 0.573-0.805. The optimal cut-off point for CRP in this data set at 5 mg/L, achieved sensitivity of 0.61, specificity of 0.71, and likelihood ratio 2.11 (Kappa 0.003, McNemar 0.711) for the detection of bacterial infection in this population. The Quantitative CRP concentration is a valuable laboratory test for the evaluation of febrile children who are at risk of bacterial infection.     Pemeriksaan C-reactive protein (CRP), merupakan protein fase akut yang disintesis oleh hepatosit, berguna untuk membedakan infeksi bakteri dengan infeksi non-bakteri pada anak. Tujuan penelitian ini adalah untuk mengetahui nilai diagnostik CRP kuantitatif yang berkaitan dengan infeksi bakteri dan non-bakteri secara klinis pada anak demam. Anak demam yang dirawat di Departemen Gawat Darurat Pediatri, berusia sampai dengan 12 tahun, dengan temperatur aksila ≥38,5°C, dan secara klinis belum diketahui penyebab panas diikutkan dalam penelitian konsekutif dari September 2009 sampai Agustus 2010. Informed consent untuk izin pemeriksaan CRP. Kadar CRP diperiksa dengan metode imunoturbidimetri (Pure auto S CRP latex (SS-type), Sekisui Medical Co., Ltd) dan fotometer otomatis TMS 1024i. Diagnosis ditegakkan berdasarkan hasil pemeriksaan laboratorium, kultur darah, atau radiografi. Kurva receiver operator characteristic (ROC) dibuat untuk menunjukkan nilai optimal pemeriksaan CRP kuantitatif. Delapan puluh enam pasien diikutkan dalam penelitian. Empat puluh satu (47,6%) menderita infeksi bakteri dan 45 (52,3%) menderita infeksi non-bakteri. Kadar CRP berbeda bermakna antara kedua kelompok (p=0,003). Analisis ROC menunjukkan area under curve (AUC) 0,689; standard error (SE) 0,059; dan 95% confidence interval (CI) 0573-­­­-0,805. Nilai potong optimal CRP untuk menemukan infeksi bakteri pada populasi ini adalah 5 mg/L, dengan nilai kepekaan 0,61; kekhasan 0,71; dan likelihood ratio 2,11 (Kappa 0,003; McNemar 0,711). Pemeriksaan CRP kuantitatif merupakan pemeriksaan laboratorium yang baik untuk evaluasi anak demam yang berkebahayaan infeksi bakteri.