Evaluation of C-reactive protein and serum amyloid A in the detection of inflammatory and infectious diseases in children / Avaliação de marcadores de fase aguda em crianças atendidas em um serviço de urgencia

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Introduction: the acute-phase response consists of a complex network of events involving various cells and pro anti-inflammatory mediators. The clinical diagnosis of this condition is not always easily obtained. The performance of several markers of the acute response is constantly evaluated in different groups of diseases, aiming to optimize the diagnosis and in order to establish a precise therapeutic in a short time. In addition to parameters such as those related to leukocyte and erythrocyte sedimentation rate (ESR), the determination of levels of proteins such as C-reactive protein (CR-P) and serum amyloid A (SAA) are proposed as useful in detecting the presence of the inflammatory/infection process. The objective of this study was the assessment of some markers of inflammatory response, comparing the efficiency among them in identifying children from the emergency room with infection or inflammation suspicious. Materials and methods: a total of 90 children aged between 1 month and 10 years with a clinical suspicious to have inflammation or infection diseases attended in the Emergency Unit of Clinical Hospital of the UNICAMP were enrolled. According to clinical data, medical records and subsidiary exams, these children were divided into inflammatory (n = 17) and infectious groups (n = 66). Infectious group was subdivided into bacterial or viral infection. The following parameters were evaluated: white blood cell count and presence of immature granulocytes by automated hematology equipment and microscopic observation of blood smears, determination of PC-R by 2 systems, and measurement of SAA and IL-6 levels by commercial kits. Results: the best marker of the inflammatory/infection process was the CR-P (>80% positivity from both systems), followed by SAA (73.3%) and ESR (72.1%). The leukocyte count and the detection of immature granulocytes showed performance below the recommended and, consequently not useful for diagnosis. There was no difference in the values of leukocytes, ESR, CR-P, SAA and IL-6 between inflammatory and infectious groups, but higher leukocyte counting, PC-R and SAA levels were observed in the bacterial group when compared to the viral one. Conclusions: The CR-P was the biomarker with better performance in the group of children studied, while information supplied by the blood cells analysis identified the smallest number of patients. The results of SAA was similar to PC-R; therefore is questionable the SAA measurement utility in routine diagnosis. According to our data, the association of more than one parameter in the detection of the inflammatory/ infection response should be encouraged

ASSUNTO(S)

inflamação reação de fase aguda acute-phase reaction inflammation emergency care serviços medicos de emergencia

ACESSO AO ARTIGO

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