Author/Editor		Tonin, I; Vidmar, M; Čižman, M
Title		C-reaktivni protein in skrajna levkocitoza v diagnostiki akutno nastale vročine brez žariščnih znakov bolezni pri otrocih
Translated title		Diagnostic value of C-reactive protein and extreme leukocytosis in febrile children without localizing signs
Type		članek
Source		Slov Pediatr
Vol. and No.		Letnik 14, št. 4
Publication year		2007
Volume		str. 160-8
Language		slo
Abstract		Background. Determining the level of C-reactive protein assists in the detection of serious bacterial infections. The value of C-reactive protein is higher in bacterial infections and remains low in viral infections. However, there is no clear cut-off value between bacterial and viral infections hence the C-reactive protein value alone is insufficient to determine the cause of the infection. Aim. The purpose of our study was to establish the importance of indicators of acute infection, which can be routinely checked in children suffering from acute fever who do not have a localized infection. We aimed to determine whether extreme leucocytosis increases the likelihood that the child is suffering from a bacterial infection, which should be treated with antibiotics. Our aim was also to establish the importance of repeated determination of the indicators of infection in acutely febrile children without localizing signs. Methods. The retrospective research included 333 children aged 0 to 14 years, who were diagnosed as »febrile state« in 2003 and referred to the University Medical Centre, Department of Infecrious Diseases in Ljubljana. For a more comprehensive classification of invasive bacterial infections we also examined an additional 26 records from the years 2004 and 2005, where the diagnosis was either bacteraemia or meningitis. Student's t-test, Mann-Whitney U-test and hi-square test were used to compare the values of the bacterial and viral infections. The differences were considered statistically significant when the level of risk was less than 0.05 (p < 0.05). Results. The sensitivity of C-reactive protein with a leucocyte count of > 15.0 X 109/1 was 72.8 % and specificiiy was 67.2%, PPV 73% and NPV 67%. (Abstract truncated at 2000 characters)
Summary		Izhodišče. Z določanjem vrednosti C-reaktivnega proteina si pomagamo pri odlaivanju resnih bakterijskih okužb. Vrednost C-reaktivnega proteina se zviša pri bakterijskih in ostane nizka pri virusnih okužbah. Za razlikovanje bakterijske in virusne okužbe ni neke absolutne meje, zato vrednost C-reaktivnega proteina kot samostojen označevalec ni dovolj zanesljiva za določitev vrste okužbe. Namen. Namen našega dela je bil ugotoviti pomen merjenja akutnih kazalcev vnetja, ki jih pri otroku z akutno vročino in brez umestitve okužbe določamo rutinsko. Želeli smo ugotoviti, ali visoka levkocitoza poveča verjetnost, da ima otrok bakterijsko okužbo, ki jo moramo zdraviti z antibiotiki. Prav tako smo želeli ugotoviti tudi pomen večkratnega določanja vrednosti kazalcev vnetja pri otrocih z akutno nastalo vročino brez umestitve. Metode. V retrospektivno raziskavo smo vključili 333 otrok, starih od 0 do l4 let, ki so bili v letu 2003 napoteni na Kliniko za infekcijske bolezni in vročinska stanja v Ljubljani z napotno diagnozo »status febriliso. Zaradi lažje obravnave invazivnih bakterijskih okužb smo naknadno pregledali še 26 popisov iz leta 2004 in 2005 z odpustno diagnozo bakteriemija ali meningitis. Za primerjavo vrednosti med skupino bakterijskih in skupino virusnih okužb smo uporabili Studentov t-test, Mann-Whitney U-test in hi-kvadrat test. Razlike smo imeli za statistično značilne, kadar je bila stopnja tveganja manjša od 0,05 (p < 0,05). Rezultati. Ob številu levkocitov > 15,0 X 109/1 je bila občutljivost C-reaktivnega proteina, 72,8% in specifičnost 67,2%, pozitivna napovedana vrednost 73% in negativna napovedana vrednost 67%. Ponovno določanje vrednosti C-reaktivnega proteina v prvih 48 urah je smiselno za določitev invazivnih bakterijskih okužb, medtem ko določanje po 48 urah pa ne poveča verjetnosti za določitev bakterijske okužbe. Skrajna levkocitoza je bila prisotna pri 22% otrok. (Izvleček skrajšan pri 2000 znakih)
Descriptors		LEUKOCYTOSIS C-REACTIVE PROTEIN FEVER BACTERIAL INFECTIONS ADENOVIRUS INFECTIONS, HUMAN CHILD