Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Apr 28, 2017; 9(4): 206-211
Published online Apr 28, 2017. doi: 10.4329/wjr.v9.i4.206
C-reactive protein and radiographic findings of lower respiratory tract infection in infants
Maria Twomey, Hannah Fleming, Fiachra Moloney, Kevin P Murphy, Lee Crush, Siobhan B O’Neill, Oisin Flanagan, Karl James, Conor Bogue, Owen J O’Connor, Michael M Maher
Maria Twomey, Hannah Fleming, Fiachra Moloney, Kevin P Murphy, Lee Crush, Siobhan B O’Neill, Oisin Flanagan, Karl James, Conor Bogue, Owen J O’Connor, Michael M Maher, Department of Radiology, Cork University Hospital, Wilton, T12 DC4A Cork, Ireland
Author contributions: Twomey M drafted the manuscript; Fleming H collected the data and drafted the manuscript; Moloney F collected data and performed statistical analysis; Murphy KP collected the data; Crush L collected data and reported the chest radiographs; O’Neill SB collected the data and performed data analysis; Flanagan O was involved in data analysis, drafting the manuscript and editing; James K redrafted and revised the manuscript, created the audio file and added supplementary comments; Bogue C edited the manuscript; O’Connor OJ edited the manuscript; Maher MM designed the research study and oversaw all aspects of the study.
Institutional review board statement: The study was reviewed and approved by the Cork Clinical Research Ethics Committee, Lancaster Hall, Cork, Ireland.
Informed consent statement: Informed consent was not deemed necessary for this study. Clinical and radiological data was collected retrospectively in an anonymised fashion and no patient underwent additional procedures or investigations as a result of recruitment to the study. Ethical approval was granted without a requirement for informed consent.
Conflict-of-interest statement: All authors wish to declare no conflicts of interest.
Data sharing statement: The technical appendix, statistical code, and dataset are available form the corresponding author at drkarljames@outlook.com. Informed consent was not obtained but the presented data are anonymised and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Karl James, FFR RCSI, Department of Radiology, Cork University Hospital, 1 Bishopstown Road, Wilton, T12 DC4A Cork, Ireland. drkarljames@outlook.com
Telephone: +353-021-4920288 Fax: +353-021-4922002
Received: June 14, 2016
Peer-review started: June 17, 2016
First decision: July 27, 2016
Revised: August 10, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: April 28, 2017
Processing time: 318 Days and 1.2 Hours
Abstract
AIM

To evaluate the association between C-reactive protein (CRP) and radiological evidence of lower respiratory tract infection (LRTI) in infants.

METHODS

All patients aged less than 4 years who presented with suspected lower respiratory tract infection, who received a peri-presentation chest radiograph and CRP blood measurement over an 18-mo period were included in the study. Age, gender, source of referral, CRP, white cell count, neutrophil count along with the patients’ symptoms and radiologist’s report were recorded.

RESULTS

Three hundred and eleven patients met the inclusion criteria. Abnormal chest radiographs were more common in patients with elevated CRP levels (P < 0.01). Radiologic signs of LRTI were identified in 73.7% of chest radiographs when a patient had a CRP level between 50-99 mg/L. CRP levels were a better predictor of positive chest radiograph findings for those aged greater than I year compared to those 1 year or less.

CONCLUSION

CRP may be used in patients with suspected LRTI diagnosis to select those who are likely to have positive findings on chest radiograph, thus reducing unnecessary chest radiographs.

Keywords: Chest radiograph; C-reactive protein; Chest infection; Respiratory infection; Pediatric

Core tip: Abnormal chest radiograph findings are significantly more common in patients with elevated C-reactive protein (CRP) levels. Young children are most likely to have abnormal chest radiograph findings if they have all three of the following; a CRP level of 50-99 mg/L, respiratory symptoms and if they are aged greater than 1 year.