Clinical implications of extremely elevated C-reactive protein among febrile immunocompetent children

Shirley Saar, Oded Scheuerman, Tarek Zuabi, Gil Amarilyo, Mor Abu, Lotem Goldberg, Bar Goldberg, Nina Shirman, Yoav Vardi, Yehonatan Pasternak, Yoel Levinsky*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Aim: To identify the various diagnoses associated with extremely elevated C-reactive protein (CRP) (>30 mg/dL) among immunocompetent children and to evaluate its clinical implications during emergency department (ED) workup and hospital management. Methods: Children (3 months–18 years) with fever in ED were included, retrospectively. The cohort was divided into two groups—‘extremely elevated CRP’ (>30 mg/dL) and ‘highly elevated CRP’ (15–30 mg/dL). Results: Included were 1173 patients with CRP 15–30 mg/dL and 221 with CRP > 30 mg/dL. Bacterial infection was more prevalent among the extremely elevated CRP group (94.1% vs. 78.5%, respectively, p = 0.002). Specifically, bacterial pneumonia (52%), cellulitis (7.2%) and sepsis (4.1%) were more prevalent among this group. More of these patients were reported as ‘Ill appearing’ [78 (35.3%) vs. 166 (17.4%), p < 0.001]. They were more often treated with fluids [33 (14.9%) vs. 50 (5.3%), p < 0.001] and a higher portion of them required admission to an intensive care unit [11 (5.0%) vs. 16 (1.7%), p = 0.007]. Conclusion: Febrile children with extremely elevated CRP showed greater illness severity (haemodynamic instability, PICU admissions), thus careful clinical attention is desirable in these cases. More than half of them had bacterial pneumonia, which reinforces the importance of relevant investigation when diagnosis is unclear.

Original languageEnglish
Pages (from-to)531-536
Number of pages6
JournalActa Paediatrica, International Journal of Paediatrics
Issue number3
StatePublished - Mar 2024


  • CRP
  • bacterial infection
  • fever
  • paediatrics


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