UK: Serum C-reactive protein (CRP) level is not sufficiently accurate to aid diagnosis or to inform treatment decisions in infants with suspected late-onset infection, a recent review in the journal JAMA Pediatrics has suggested.
According to the study, determination of serum CRP level of an initial evaluation of an infant with suspected late-onset infection is unlikely to aid early diagnosis or to select infants to undergo further investigation or treatment with antimicrobial therapy or other interventions.
Jennifer Valeska Elli Brown, Centre for Reviews and Dissemination, University of York, York, United Kingdom, and colleagues conducted this systematic review and meta-analysis of 22 cohort studies to compare the accuracy of serum C-reactive protein (CRP) with that of microbiological blood culture for diagnosing late-onset infection in newborns.
The review included 22 cohort and cross-sectional studies comprising of 2255 infants. The studies that compared the accuracy of serum CRP levels with microbiological culture results to diagnose late-onset (>72 hours after birth) infection in newborns (any gestational age) hospitalized after birth were included.
The primary meta-analysis outcome was diagnostic test accuracy of serum CRP level taken at the initial investigation of an infant with suspected late-onset infection.
Key findings of the study include:
Participants in most studies were preterm (<37 weeks) or very low-birth weight (<1500 g) infants. Two studies additionally enrolled infants born at term.
Most studies (14 of 16) used a prespecified CRP level cutoff for a "positive" index test (5-10 mg/L) and the culture of a pathogenic microorganism from blood as the reference standard.
Risk of bias was low with independent assessment of index and reference tests.
At median specificity (0.74), pooled sensitivity was 0.62 (95% CI, 0.50-0.72).
Adding serum CRP level to the assessment of an infant with a 40% pretest probability of late-onset infection (the median for the included studies) generated posttest probabilities of 26% for a negative test result and 61% for a positive test result.
The study, "Assessment of C-Reactive Protein Diagnostic Test Accuracy for Late-Onset Infection in Newborn Infants: A Systematic Review and Meta-analysis," is published in the journal JAMA Pediatrics.
DOI: 10.1001/jamapediatrics.2019.5669