{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:41:09Z","timestamp":1747183269579,"version":"3.40.5"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,16]],"date-time":"2023-12-16T00:00:00Z","timestamp":1702684800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To identify the various diagnoses associated with extremely elevated C\u2010reactive protein (CRP) (&gt;30\u2009mg\/dL) among immunocompetent children and to evaluate its clinical implications during emergency department (ED) workup and hospital management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children (3\u2009months\u201318\u2009years) with fever in ED were included, retrospectively. The cohort was divided into two groups\u2014\u2018extremely elevated CRP\u2019 (&gt;30\u2009mg\/dL) and \u2018highly elevated CRP\u2019 (15\u201330\u2009mg\/dL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Included were 1173 patients with CRP 15\u201330\u2009mg\/dL and 221 with CRP\u2009&gt;\u200930\u2009mg\/dL. Bacterial infection was more prevalent among the extremely elevated CRP group (94.1% vs. 78.5%, respectively, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Specifically, bacterial pneumonia (52%), cellulitis (7.2%) and sepsis (4.1%) were more prevalent among this group. More of these patients were reported as \u2018Ill appearing\u2019 [78 (35.3%) vs. 166 (17.4%), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]. They were more often treated with fluids [33 (14.9%) vs. 50 (5.3%), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001] and a higher portion of them required admission to an intensive care unit [11 (5.0%) vs. 16 (1.7%), <jats:italic>p<\/jats:italic>\u2009=\u20090.007].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.17060","type":"journal-article","created":{"date-parts":[[2023,12,16]],"date-time":"2023-12-16T10:05:15Z","timestamp":1702721115000},"page":"531-536","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical implications of extremely elevated C\u2010reactive protein among febrile immunocompetent children"],"prefix":"10.1111","volume":"113","author":[{"given":"Shirley","family":"Saar","sequence":"first","affiliation":[{"name":"Department of Pediatrics B Schneider Children's Medical Center of Israel  Petah Tiqva Israel"},{"name":"Faculty of Medicine Tel Aviv University  Tel Aviv 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