Quantitative C‐reactive Protein (CRP) Determined by an Immunoturbidimetric Method in Rapid Differential Diagnosis of Acute Bacterial and Viral Diseases of Children

Peltola, H; Laipio, Marja-Leena; Siimes, Martti A.

doi:10.1111/j.1651-2227.1984.tb09944.x

Cited by 43 publications

(22 citation statements)

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“…Our experience and that of others also suggest that the test may be helpful in discriminating between viral and bacterial infections, whereas the latex test is of little value in this connection [5,7,9]. Selection of those patients who will benefit from antibiotic therapy is very important clinically.…”

Section: Discussionmentioning

confidence: 74%

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C-reactive protein as an indicator of infection in the immunosuppressed child

et al. 1986

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C-reactive protein (CRP) concentrations were determined in a prospective fashion in 50 children with malignant disease. In 35 children with active and aggressive disease, but without signs of infection, no significant increase in CRP was detected. Neither did aggressive cytostatic therapy (70 courses) in non-infected children result in an increase. In bacteriologically proven, and in clinical sepsis-suspected cases, CRP values increased in all cases to levels above 100 mg/l (normal values less than 5 mg/l). Effective antibiotic therapy resulted in a prompt decline in CRP. Viral infections resulted in a much smaller increase. We conclude that serial measurements of CRP in these immunosuppressed children are of great help in monitoring infections and defining the group that needs antibiotic therapy. The measurement is also a good indicator of the effectiveness of the antibiotic therapy chosen.

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Section: Discussionmentioning

confidence: 74%

“…Selection of those patients who will benefit from antibiotic therapy is very important clinically. Patients with viral disease or fever of non-infectious origin, on the other hand, are also important to identify, as they do not benefit from antibiotic therapy [7,9].…”

Section: Discussionmentioning

confidence: 99%

C-reactive protein as an indicator of infection in the immunosuppressed child

et al. 1986

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“…Routine investigations included measurement of the ESR (8 times) and serum C-reactive protein 14 levels (12 times from finger-tip specimens 15 ) and radiography (4 times). Special follow-up forms were completed and all patients were followed up for at least 12 months.…”

Section: Methodsmentioning

confidence: 99%

Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination

Peltola

Kallio

Unkila‐Kallio

1998

The Journal of Bone and Joint Surgery. British volume

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“…1 This is no surprise; CRP is an acute phase protein and a well-documented marker of infections and sepsis. 5 However, the higher performance of CRP in predicting death/BPD at 36 weeks might result from a narrowing of the distribution of CRP concentrations in this population of low birth weight infants.…”

mentioning

confidence: 93%

Zero-filled values enhanced the performance of CRP vs RBP: TTR index in ELBW infants

Rosales

2006

J Perinatol

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Recently, Ambalavanan et al. 1 reported on the usefulness of the retinol-binding protein to transthyretin (RBP:TTR) index in assessing vitamin A status of extremely low birth weight (ELBW) infants 28 days after being dosed with vitamin A supplements. The authors demonstrated that the index was more accurate than retinol alone or RBP alone 1,2 in determining vitamin A status during inflammation. Moreover, they used the RBP:TTR index to predict the likelihood of death/bronchopulmonary dysplasia (BPD) in this population. 1 However, the index was developed as a biomarker of vitamin A status and not as a marker of morbidity or sepsis. 3,4 Although the authors did not provide an explanation for this analysis, they compared the index to C-reactive protein (CRP). They showed using receiver operating characteristics curve (ROC) analysis that the area-under-the-curve (AUC) for CRP (0.85, confidence interval (CI) 0.76-0.92) was higher than for the RBP:TTR index (0.68, CI 0.57-0.78) albeit a non-significant difference. 1 This is no surprise; CRP is an acute phase protein and a well-documented marker of infections and sepsis. 5 However, the higher performance of CRP in predicting death/BPD at 36 weeks might result from a narrowing of the distribution of CRP concentrations in this population of low birth weight infants.In Figures 1 and 3, 1 15-20% of CRP concentrations were zerofilled values, whereas for the other analytes, including RBP and TTR, the spectrum of values was wide including low and high concentrations. This caused a spectrum bias by narrowing the CRP test preferentially to detectable high concentrations, undoubtedly, from infants with morbidity and sepsis and thus, infants with higher risk of dying. The test's performance, that is, higher AUC, for CRP was higher because of this spectrum bias; however, this was not the case for the RBP:TTR index, whose distribution of values included equally non-disease and disease infants. Although spectrum bias results from how characteristics of patient are used in selecting the study population, 6 in the present case, it appears to have originated from how CRP concentrations were determined. Thus, this bias cannot be considered a spectrum effect for which reporting the characteristics of the population would suffice in correcting it. 6 The determination of CRP concentrations was based on a commercially available radial immuno-diffusion kit (The Binding Site Inc., San Diego, CA, USA). The range for detection and quantification for this kit is 5. 2-52.0 mg/l. 7 This means that CRP concentrations that were not quantified with this test were given zero values, and those with values p5.0 mg/l were probably calculated by extrapolating from outside the discrete set of reference concentrations (i.e., 2-3 standards) provided by the manufacturer. In this case, zero values or extrapolations may not be reliable and these results need to be validated against a test capable of measuring low CRP concentrations. If this error is not taken into account, the statistical inference from the AUC...

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Quantitative C‐reactive Protein (CRP) Determined by an Immunoturbidimetric Method in Rapid Differential Diagnosis of Acute Bacterial and Viral Diseases of Children

Cited by 43 publications

References 9 publications

C-reactive protein as an indicator of infection in the immunosuppressed child

C-reactive protein as an indicator of infection in the immunosuppressed child

Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination

Zero-filled values enhanced the performance of CRP vs RBP: TTR index in ELBW infants

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