The utility of serum C-reactive protein in differentiating bacterial from nonbacterial pneumonia in children: a meta-analysis of 1230 children.

摘要: Background: Differentiating bacterial from nonbacterial community-acquired pneumonia in children is difficult. Although several studies have evaluated serum concentrations of C-reactive protein (CRP) as a predictor this patient population, the utility test remains unclear. Objective: The purpose meta-analysis was to quantitatively define CRP acutely ill children. Methods: Multiple databases were searched, bibliographies reviewed, and 2 authorities field queried. Studies included if: (1) population between 1 month 18 years age; (2) quantified all subjects part initial evaluation suspected, infectious, pulmonary process; (3) cutoff concentration 30 60 mg/dL used distinguish pneumonia; (4) some criteria applied differentiate or viral (5) patients ill; (6) chest radiograph obtained evaluation. quality each study determined across 4 metrics: diagnostic criteria; design; exclusion chronically human immunodeficiency virus infected subjects; who recently received antibiotics. Data extracted article; primary outcome measure odds ratio with mixed etiology exceeding 30-60 mg/L. Heterogeneity among by Cochran's Q statistic; methods both Mantel Haenszel, DerSimonian Laird combine results. Results: Eight fulfilled inclusion criteria. Combining demonstrated pooled 1230 incidence infection 41%. Children significantly more likely 35-60 mg/L than infections (odds = 2.58, 95% confidence interval 1.20-5.55). Sensitivity analysis that difference robust. There significant heterogeneity 8 (Q 37.7, P < 0.001, I 81.4) remained throughout sensitivity analysis. Conclusions: In pneumonia, 40-60 weakly predict etiology.