title: Association between C-reactive protein levels and outcome in acute lung injury in children.
abstract: High plasma C-reactive protein (CRP) levels are associated with favorable outcome in adults with acute lung injury (ALI). The association between CRP levels and outcome has not been studied in ALI in children. We performed a historical cohort study in 93 mechanically ventilated children (0-18 years) with ALI. The CRP level within 48 h of disease onset was tested for association with 28-day mortality and ventilator-free days (VFD). Clinical parameters and ventilator settings were evaluated for possible confounding. Fourteen patients died within 28 days. The median (interquartile range) CRP level in nonsurvivors was 126 mg/L (64; 187) compared with 56 mg/L (20; 105) in survivors (p = 0.01). For every 10-mg/L rise in CRP level, the unadjusted odds (95% confidence interval (95% CI)) for mortality increased 8.7% (2.1-15.8%). Cardiovascular organ failure at onset of ALI was the strongest predictor for mortality (odds ratio, 30.5 (6.2-152.5)). After adjustment for cardiovascular organ failure, for every 10-mg/L rise in CRP level, the OR (95% CI) for mortality increased 4.7% (-2.7-12.6%; p = 0.22). Increased CRP levels were associated with a decrease in VFD (ρ = -0.26, p = 0.01).
  
  
  CONCLUSIONS
  increased plasma CRP levels are not associated with favorable outcome in ALI in children. This is in contrast with findings in adults with ALI.
authors: Pediatric Intensive Care Unit, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. m.bruijn@amc.nl
authors: M
authors: M
authors: Bruijn
authors: E M
authors: EM
authors: Jansen
authors: T
authors: T
authors: Klapwijk
authors: J H
authors: JH
authors: van der Lee
authors: R R
authors: RR
authors: van Rijn
authors: J B M
authors: JB
authors: van Woensel
authors: A P
authors: AP
authors: Bos
mesh_terms: D055371:Acute Lung Injury / Q000097:blood* / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D012121:Respiration, Artificial; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
references: Pediatr Crit Care Med. 2007 Jul;8(4):317-23
references: 17545931
references: Crit Care Med. 2012 Feb;40(2):587-93
references: 21946655
references: Crit Care Med. 2002 Aug;30(8):1772-7
references: 12163791
references: N Engl J Med. 2000 May 4;342(18):1334-49
references: 10793167
references: Pediatr Infect Dis J. 1997 Aug;16(8):735-46; quiz 746-7
references: 9271034
references: Am J Respir Crit Care Med. 2010 Dec 15;182(12):1465-74
references: 20732987
references: Crit Care Med. 2002 Apr;30(4):757-62
references: 11940741
references: Crit Care Med. 2011 Dec;39(12):2645-51
references: 21725235
references: Crit Care Med. 1988 Nov;16(11):1110-6
references: 3048900
references: Crit Care Med. 2009 Aug;37(8):2448-54
references: 19531940
references: Intensive Care Med. 2007 Mar;33(3):477-84
references: 17260130
references: Crit Care. 2011;15(2):R78
references: 21366899
references: Pediatrics. 2009 Jul;124(1):87-95
references: 19564287
references: Intensive Care Med. 1994;20(3):225-32
references: 8014293
references: World J Pediatr. 2012 Feb;8(1):43-6
references: 22282381
references: Chest. 2009 Aug;136(2):471-480
references: 19411291
references: Clin Infect Dis. 1997 Sep;25(3):640-6
references: 9314453