Summary of Ahout, I et al; Prospective observational study in two Dutch hospitals to assess the performance of inflammatory plasma markers to determine disease severity of viral respiratory tract infections in children. BMJ Open 2017. Click here for the full article.

Lower respiratory tract infections (LRTIs) are a major cause of hospital admissions in children. Viruses are the most common cause and the course of these infections is unpredictable with potential fast deterioration into respiratory failure. Currently, it is difficult to improve clinical judgement on aspects such as length of hospitalization and ICU admission due to the fact that this is generally based on subjective criteria. The aim of this study was to determine whether systemic inflammatory markers can be used to predict severity of disease in children with respiratory viral infections.

Blood was collected from 104 children <3 years of age with viral LRTI in an acute setting (within 24 hours) and in the recovery phase (4-6 weeks). Plasma protein levels of SAA, SAP, PTX3, properdin and CRP were determined by ELISA to investigate potential indicators of disease severity.

The results demonstrated that plasma levels of CRP, SAP, SAA and PTX3 increased significantly during the acute phase. Properdin levels did not differ between the acute phase and the recovery phase, but it did drop significantly in patients with severe disease. SAA levels were significantly elevated in relation to disease severity. Additionally, both CRP and properdin correlated significantly with duration of hospitalization.

This study has proven the clinical relevance of plasma markers such as CRP, PTX3, SAA and properdin in children with acute viral LRTI. However, a combination of these markers significantly enhances the accuracy of identifying patients with severe disease […] and might provide additive value in clinical decision-making.