Association of C-reactive protein with bacterial and respiratory syncytial virus-associated pneumonia among children aged <5 years in the PERCH study

PERCH Study Group

Research output: Contribution to journalArticle

Abstract

Background. Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods. We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results. Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIVnegative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions. Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.

Original languageEnglish (US)
Pages (from-to)S378-S386
JournalClinical Infectious Diseases
Volume64
DOIs
StatePublished - Jan 1 2017

Fingerprint

Respiratory Syncytial Viruses
C-Reactive Protein
Pneumonia
Bacterial Pneumonia
Research
Viral Pneumonia
ROC Curve
Child Health
Sensitivity and Specificity
Polymerase Chain Reaction
Sputum
Area Under Curve
Case-Control Studies
Blood Proteins
HIV

Keywords

  • Bacteria
  • Biomarker
  • C-reactive protein
  • Pneumonia
  • RSV

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{3ff8e322f107486fbf36f7f40b7973ad,
title = "Association of C-reactive protein with bacterial and respiratory syncytial virus-associated pneumonia among children aged <5 years in the PERCH study",
abstract = "Background. Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods. We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for {"}confirmed{"} bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to {"}RSV pneumonia{"} (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results. Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3{\%} had CRP ≥40 mg/L. Among 119 HIVnegative cases with confirmed bacterial pneumonia, 77{\%} had CRP ≥40 mg/L compared with 17{\%} of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77{\%}) from RSV pneumonia (specificity 82{\%}). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions. Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.",
keywords = "Bacteria, Biomarker, C-reactive protein, Pneumonia, RSV",
author = "{PERCH Study Group} and Melissa Higdon and Tham Le and O'Brien, {Katherine L} and Murdoch, {David R.} and Christine Prosperi and Baggett, {Henry C.} and Brooks, {W Abdullah} and Daniel Feikin and Hammitt, {Laura L} and Howie, {Stephen R.C.} and Kotloff, {Karen L.} and Levine, {Orin S.} and Scott, {J. Anthony G.} and Thea, {Donald M.} and Awori, {Juliet O.} and Baillie, {Vicky L.} and Stephanie Cascio and Somchai Chuananon and Andrea Deluca and Driscoll, {Amanda J.} and Ebruke, {Bernard E.} and Endtz, {Hubert P.} and Anek Kaewpan and Geoff Kahn and Angela Karani and Karron, {Ruth A} and Moore, {David P.} and Park, {Daniel E.} and Rahman, {Mohammed Ziaur} and Rasheed Salaudeen and Phil Seidenberg and Somwe, {Somwe Wa} and Mamadou Sylla and Tapia, {Milagritos D.} and Scott Zeger and Knoll, {Maria Deloria} and Madhi, {Shabir A.} and Nicholas Fancourt and Wei Fu and Kagucia, {Eunice Wangeci} and Mengying Li and Zhenke Wu and Watson, {Nora L.} and Jane Crawley and Khalequ Zaman and Doli Goswami and Lokman Hossain and Yasmin Jahan and Hasan Ashraf and Martin Antonio",
year = "2017",
month = "1",
day = "1",
doi = "10.1093/cid/cix150",
language = "English (US)",
volume = "64",
pages = "S378--S386",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - Association of C-reactive protein with bacterial and respiratory syncytial virus-associated pneumonia among children aged <5 years in the PERCH study

AU - PERCH Study Group

AU - Higdon, Melissa

AU - Le, Tham

AU - O'Brien, Katherine L

AU - Murdoch, David R.

AU - Prosperi, Christine

AU - Baggett, Henry C.

AU - Brooks, W Abdullah

AU - Feikin, Daniel

AU - Hammitt, Laura L

AU - Howie, Stephen R.C.

AU - Kotloff, Karen L.

AU - Levine, Orin S.

AU - Scott, J. Anthony G.

AU - Thea, Donald M.

AU - Awori, Juliet O.

AU - Baillie, Vicky L.

AU - Cascio, Stephanie

AU - Chuananon, Somchai

AU - Deluca, Andrea

AU - Driscoll, Amanda J.

AU - Ebruke, Bernard E.

AU - Endtz, Hubert P.

AU - Kaewpan, Anek

AU - Kahn, Geoff

AU - Karani, Angela

AU - Karron, Ruth A

AU - Moore, David P.

AU - Park, Daniel E.

AU - Rahman, Mohammed Ziaur

AU - Salaudeen, Rasheed

AU - Seidenberg, Phil

AU - Somwe, Somwe Wa

AU - Sylla, Mamadou

AU - Tapia, Milagritos D.

AU - Zeger, Scott

AU - Knoll, Maria Deloria

AU - Madhi, Shabir A.

AU - Fancourt, Nicholas

AU - Fu, Wei

AU - Kagucia, Eunice Wangeci

AU - Li, Mengying

AU - Wu, Zhenke

AU - Watson, Nora L.

AU - Crawley, Jane

AU - Zaman, Khalequ

AU - Goswami, Doli

AU - Hossain, Lokman

AU - Jahan, Yasmin

AU - Ashraf, Hasan

AU - Antonio, Martin

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background. Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods. We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results. Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIVnegative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions. Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.

AB - Background. Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods. We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results. Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIVnegative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions. Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.

KW - Bacteria

KW - Biomarker

KW - C-reactive protein

KW - Pneumonia

KW - RSV

UR - http://www.scopus.com/inward/record.url?scp=85038085859&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038085859&partnerID=8YFLogxK

U2 - 10.1093/cid/cix150

DO - 10.1093/cid/cix150

M3 - Article

C2 - 28575375

AN - SCOPUS:85038085859

VL - 64

SP - S378-S386

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

ER -