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. 2019 Jun;58(7):752-760.
doi: 10.1177/0009922819837352. Epub 2019 Mar 31.

C-Reactive Protein and Ferritin Are Associated With Organ Dysfunction and Mortality in Hospitalized Children

Christopher M Horvat  1   2 , Jamie Bell  3 , Sajel Kantawala  2 , Alicia K Au  1   2 , Robert S B Clark  1   2 , Joseph A Carcillo  1   2
Affiliations

C-Reactive Protein and Ferritin Are Associated With Organ Dysfunction and Mortality in Hospitalized Children

Christopher M Horvat et al. Clin Pediatr (Phila). 2019 Jun.

Abstract

Our objective was to determine if C-reactive protein (CRP) and ferritin values alone and in combination are associated with mortality among hospitalized children. All hospitalized patients at our institution with a CRP or ferritin assay in 2015 and 2016 were included. Area under the receiver operating curves (AUROC) were examined, optimal cut-points determined, and patients were stratified into low-, intermediate-, or high-risk groups based on elevation of zero, one, or both biomarkers. A total of 14 928 CRP and 653 ferritin values were obtained, with both obtained for 172 patients. AUROC for maximum CRP value was 0.76 (0.68-0.85) with a cut-point of 7.1 mg/dL for in-hospital mortality and 0.90 (0.83-0.98) for maximum ferritin with a cut-point of 373 ng/mL. Elevation of both ferritin and CRP was associated with the highest inpatient mortality (21.7%) and greatest organ dysfunction, followed by either biomarker alone. Additional prospective study of these biomarkers in combination is warranted.

Keywords: C-reactive protein; electronic health record; ferritin; learning health system; multiple organ dysfunction.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1.
Figure 1.
Risk contingency table for mortality and organ dysfunction based on cut-points for C-reactive protein and ferritin and patients’ maximum value for each biomarker.
Figure 2.
Figure 2.
Receiver operating characteristic curves for 90-day mortality and maximum ferritin (red line) and CRP (blue line), with cut-points displayed for each biomarker and parentheses noting (sensitivity, specificity) at each cut-point.
Figure 3.
Figure 3.
Notch plots of maximum and last values of (a) CRP and (b) ferritin for both survivors and non-survivors
Figure 3.
Figure 3.
Notch plots of maximum and last values of (a) CRP and (b) ferritin for both survivors and non-survivors
See this image and copyright information in PMC

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