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Boletín Médico del Hospital Infantil de México

2012, Number 5

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Bol Med Hosp Infant Mex 2012; 69 (5)

Usefulness of C-reactive protein in the diagnosis of bacterial infection in the pediatric patient with cancer, fever and neutropenia

Penagos PM, Villasís KMG, Miranda NMG, Tapia MA, Rivera MH, Bernáldez RR, López AE, Solórzano SF

Language: Spanish
References: 26
Page: 376-383
PDF size: 233.66 Kb.


ABSTRACT

Background. Diagnosis of bacterial infection in the patient with cancer, fever and neutropenia is difficult due to the poor inflammatory response. Several evaluations of acute phase reactants such as C-reactive protein (C-RP) have been performed with diverse results. The aim of this study was to calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and likelihood ratios (LR) for C-RP in the diagnosis of bacterial infection of patients with cancer, neutropenia and fever.
Methods. We carried out a diagnostic test study. Pediatric patients with cancer and neutropenia (‹500 NA/mm3) were selected. C-RP was determined by nephelometry. Episodes were classified into the following groups: group I: microbiologically documented infection; group II: clinically documented infection; group III: fever of unknown origin; group IV: patients with neutropenia without fever. Sensitivity, specificity, PPV, NPV, receiving operating curves (ROC) and LR were calculated. Mann-Whitney U test and Kruskal-Wallis test were used for comparison of quantitative variables. For qualitative variables, χ2 test was used.
Results. There were 127 episodes distributed as follows: 29, 47, 20 and 31 for groups I, II, III and IV, respectively. Median of C-RP values were 282 mg/L for group I, 205 mg/L group II, 27.3 mg/L group III and 5.1 mg/L group IV (p ‹0.001). With a C-RP value of 60 mg/L, we obtained a sensitivity of 94%, specificity 94%, PPV 6% and NPV 92%. LR for a positive test was 15.6 and LR for a negative test was 0.06.
Conclusions. C-RP is a useful and economically feasible test for diagnosis of bacterial infection in patients with cancer, neutropenia and fever.


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