Yeungnam Univ J Med.  2020 Apr;37(2):106-111. 10.12701/yujm.2019.00402.

Predictive value of C-reactive protein for the diagnosis of meningitis in febrile infants under 3 months of age in the emergency department

• Lee TG
• Yu ST
• So CH

• KMID: 2501417
• DOI: http://doi.org/10.12701/yujm.2019.00402

Abstract

Background
Fever is a common cause of pediatric consultation in the emergency department. However, identifying the source of infection in many febrile infants is challenging because of insufficient presentation of signs and symptoms. Meningitis is a critical cause of fever in infants, and its diagnosis is confirmed invasively by lumbar puncture. This study aimed to evaluate potential laboratory markers for meningitis in febrile infants.
Methods
We retrospectively analyzed infants aged <3 months who visited the emergency department of our hospital between May 2012 and May 2017 because of fever of unknown etiology. Clinical information and laboratory data were evaluated. Receiver operating characteristic (ROC) curves were constructed.
Results
In total, 145 febrile infants aged <3 months who underwent lumbar punctures were evaluated retrospectively. The mean C-reactive protein (CRP) level was significantly higher in the meningitis group than in the non-meningitis group, whereas the mean white blood cell count or absolute neutrophil count (ANC) did not significantly differ between groups. The area under the ROC curve (AUC) for CRP was 0.779 (95% confidence interval [CI], 0.701–0.858). The AUC for the leukocyte count was 0.455 (95% CI, 0.360–0.550) and that for ANC was 0.453 (95% CI, 0.359–0.547). The CRP cut-off value of 10 mg/L was optimal for identifying possible meningitis.
Conclusion
CRP has an intrinsic predictive value for meningitis in febrile infants aged <3 months. Despite its invasiveness, a lumbar puncture may be recommended to diagnose meningitis in young, febrile infants with a CRP level >10 mg/L.

Keyword

C-reactive protein; Fever; Infants; Meningitis; Spinal puncture

Figure

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  Fig. 1. Subject enrollment flow chart shows the number of patients in each classified group.

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  Fig. 2. Receiver operating characteristic curves for CRP (p<0.05), WBC (p=0.36), and ANC (p=0.34) for predicting meningitis shows that CRP has the most valuable predictive value indicating meningitis compared to WBC and ANC. CRP, C-reactive protein; WBC, white blood cell count; ANC, absolute neutrophil count.

Reference

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