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C-reactive protein is associated with severity in hospitalized children with Respiratory Syncytial Virus bronchiolitis
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  • assaf adar,
  • Aviv Goldbart,
  • Nitzan Burrack,
  • Neta Geva,
  • Bracha Cohen,
  • Inbal Golan-Tripto
assaf adar
Soroka Medical Center
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Aviv Goldbart
Soroka Medical Center
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Nitzan Burrack
Soroka Medical Center
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Neta Geva
Soroka Medical Center
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Bracha Cohen
Soroka Medical Center
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Inbal Golan-Tripto
Soroka Medical Center

Corresponding Author:[email protected]

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Abstract

Objective: Acute bronchiolitis, primarily caused by Respiratory syncytial virus (RSV), is the most common cause of hospitalization in young children. Despite international guidelines supporting clinical diagnosis, laboratory evaluations are often conducted with limited validity. We aim to evaluate the association between C-reactive protein (CRP) levels at admission and disease severity in children hospitalized due to RSV bronchiolitis. Study design: This single center retrospective cohort study included children (0-24 months old) who were hospitalized due to RSV bronchiolitis (January 2018 – March 2022) with CRP levels taken upon admission. Clinical data and severity parameters were extracted using MD-clone platform and the clinical research unit at SUMC. Results: 1,874 children (mean age of 6.7 months, 59% males) with a median CRP level of 1.92mg/dL were included. Children with elevated CRP (>1.92mg/dL) were significantly older (5.1 vs. 3.8 months, p<0.001), had higher rates of pneumonia (9.4% vs. 4.3%, p<0.001 ), urinary tract infection (UTI), (2.2% vs. 0.2%, p<0.001), acute otitis media (AOM), (1.7% vs 0.2%, p<0.001), admissions to pediatric intensive care unit (PICU) (7.4% vs 3.7%, p<0.001), antibiotic treatment (49.8% vs 37.2%, p<0.001) and longer hospitalizations (3.83 vs 3.31 days, p=0.001). Multivariable analysis predicted increased risk for UTI, PICU admission, pneumonia, and longer hospitalization (relative risk of 11.6, 2.25, 1.98, 1.44, respectively, p<0.001)). CRP thresholds of 3.51, 1.9, and 2.81 mg/dL for PICU admission, UTI, and pneumonia, were calculated using Youden’s index with AUC of 0.72, 0.62, and 0.61, respectively. Conclusions: Elevated CRP levels at admission are associated with increased disease severity and higher complication rates in children hospitalized with RSV bronchiolitis.
25 Sep 2023Submitted to Pediatric Pulmonology
25 Sep 2023Submission Checks Completed
25 Sep 2023Assigned to Editor
25 Sep 2023Review(s) Completed, Editorial Evaluation Pending
03 Oct 2023Reviewer(s) Assigned