title: Utility of inflammatory markers in predicting the aetiology of pneumonia in children.
abstract: We aimed to investigate the diagnostic value of applying cut-off levels of inflammatory markers and to develop a prediction model for differentiation between bacterial and viral infections in paediatric community-acquired pneumonia based on C-reactive protein (CRP), neutrophil, and white cell counts (WCC). Amongst 401 children, those with bacterial pneumonia were older than those with viral pneumonia (P<0.001). Compared to viral, bacterial infections had a higher median CRP level (P<0.001), whereas WCC and neutrophil count were not different. Bacterial infections were associated with higher CRP >80 mg/L than viral infections (P=0.001), but levels <20 mg/L were not discriminatory (P=0.254). Receiver operating characteristic curve of the model for differentiating bacterial from viral pneumonia based on age, CRP, and neutrophil count produced area under the curve of 0.894 with 75.7% sensitivity and 89.4% specificity. This aetiological discriminant prediction model is a potentially useful tool in clinical management and epidemiological studies of paediatric pneumonia.
authors.affiliation: Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE1 7RU, UK. Electronic address: elemraid@doctors.org.uk.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elemraid
authors.affiliation: Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Rushton
authors.affiliation: Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Thomas
authors.affiliation: Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Spencer
authors.affiliation: Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Gennery
authors.affiliation: Department of Paediatric Infectious Disease, Royal Children's Hospital, Brisbane, Queensland 4029, Australia.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Clark
mesh_terms: D015415:Biomarkers; D002097:C-Reactive Protein; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive protein; Neutrophils; Paediatrics; Pneumonia; Prediction; White cells