title: Extremely elevated C-reactive protein levels are associated with unfavourable outcomes, including death, in paediatric patients.
abstract: OBJECTIVE
  The aim of this study was to investigate the clinical significance of extremely elevated C-reactive protein (CRP) levels in hospitalised children.
  
  
  METHODS
  We searched the electronic database of a tertiary paediatric medical centre for all patients admitted in 2010-2013 with a CRP of ≥ 30 mg/dL, and these comprised the study group. The controls were the other admissions. Data were collected on demographics, admission details, pre-existing conditions, discharge diagnosis, laboratory results and clinical outcomes.
  
  
  RESULTS
  Our study group comprised 435 (0.72%) of the 59,997 patients hospitalised during the study period. The mortality rate and mean hospital stays were significantly higher in the study group, and infectious diseases were the most common diagnoses, affecting 389 patients (89.4%), particularly pneumonia (47.1%). Higher CRP was correlated with low albumin levels (p < 0.01). Bacteraemia was the most prevalent diagnosis (38%) in the 84 oncology patients, with a crude mortality rate of 17.6%.
  
  
  CONCLUSIONS
  Infectious diseases, mainly bacterial, were the most common diagnoses in previously healthy children with CRP ≥ 30 mg/dL. Extremely elevated CRP levels were associated with an unfavourable clinical outcome, including high mortality, particularly in oncology patients. Paediatricians should be aware of the significance of extremely elevated CRP levels.
authors.affiliation: Department of Paediatrics A, Schneider Children's Medical Centre, Petach Tikva (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv), Israel.
authors.forename: Yehonatan
authors.initials: Y
authors.lastname: Pasternak
authors.affiliation: Department of Paediatrics A, Schneider Children's Medical Centre, Petach Tikva (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv), Israel.
authors.forename: Gilat
authors.initials: G
authors.lastname: Livni
authors.affiliation: Department of Paediatrics A, Schneider Children's Medical Centre, Petach Tikva (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv), Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Ashkenazi
authors.affiliation: Department of Paediatrics A, Schneider Children's Medical Centre, Petach Tikva (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv), Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lowenthal
authors.affiliation: Department of Paediatrics A, Schneider Children's Medical Centre, Petach Tikva (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv), Israel.
authors.forename: Havatzelet
authors.initials: H
authors.lastname: Yarden-Bilavsky
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Bacterial infections; C-reactive protein; Children; Inflammation; Mortality