Secretory phospholipase A2: a marker of infection in febrile children presenting to a pediatric ED.
BACKGROUND
Fever is a common presenting complaint to the emergency department (ED), and the evaluation of the febrile child remains a challenging task.


OBJECTIVE
The aim of this study was to examine the relationship between secretory phospholipase A2 (sPLA2) and infection in febrile children.


METHODS
A prospective convenience sample of children presenting with fever to an urban pediatric ED were studied. Blood and urine cultures, a complete blood count, and serum concentrations of sPLA2 were obtained, and patients were compared based on their final diagnosis of either a viral or bacterial infection.


RESULTS
In the 76 patients enrolled, 60 were diagnosed with a viral infection, 14 with a bacterial infection, 1 with Kawasaki disease, and 1 with acute lymphoblastic leukemia. The difference in the serum concentration of sPLA2 in patients with viral infections (22 ± 34 ng/mL) versus those with bacterial infections (190 ± 179 ng/mL) was statistically significant (P < .0001). Receiver operator characteristic curve analysis revealed that sPLA2 was more accurate at predicting bacterial infection (area under the curve = 0.89) than the total white blood cell count (area under the curve = 0.71) and that a value of more than 20 ng/mL had a sensitivity of 93%, specificity of 67%, positive predictive value of 39%, and negative predictive value of 97%.


CONCLUSIONS
Secretory phospholipase A2 differs significantly in children with viral versus bacterial infection and seems to be a reliable screening test for bacterial infection in febrile children.
Mansour
Karim M
KM
Children's Hospital and Research Center, Department of Emergency Medicine, Oakland, CA 94618, USA. kmansour@mail.cho.org
Kuypers
Frans A
FA
Wang
Tammy N
TN
Miller
Annabeth M
AM
Larkin
Sandra K
SK
Morris
Claudia R
CR
D000293:Adolescent; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000097:blood* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000097:blood* / Q000175:diagnosis; D007958:Leukocyte Count; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000175:diagnosis; D054497:Phospholipases A2, Secretory / Q000097:blood*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014777:Virus Diseases / Q000097:blood / Q000175:diagnosis
D015415:Biomarkers; D054497:Phospholipases A2, Secretory