Yusuf, Mariam (2021) The potential of using C reactive Protein point-of-care testing to detect bacterial infection in paediatric emergency settings. (MSc(R) thesis), Kingston University, .
Abstract
Sepsis is a life-threatening condition that can be caused by microbial infections, which can potentially lead to death of a patient in as less than 12 hours from admission. Paediatric sepsis is then further complicated by the patient’s inability to succinctly communicate their symptoms to clinicians. Microbiological diagnosis of sepsis can take a minimum of 12 hours in giving an indication of a bacterial or viral infection. Therefore, this places clinicians in a challenging time critical window into commencing an effective treatment plan, commonly results in starting a course of antibiotics immediately. This clearly shows there is a need for rapid diagnostic testing to aid clinicians. The aim of this study was to investigate the potential of using Point of Care C-Reactive Protein to differentiate between bacterial and viral infections in paediatric patient. POCT CRP was collected from the Paediatric department in Emergency Department of Chelsea and Westminster Hospital. The data was collected for 9 months in 2020 and included POCT CRP levels, haematological parameters, and clinical diagnosis. Statistical analysis of POCT CRP, Neutrophil-Lymphocyte ratio (NLR) and a novel sepsis index (SI) were analysed. A total of 662 samples were collected however after the data cleaning process, 250 sample were removed leaving a total of 412 in the clinical diagnosis group. Through analysing hospital records, it was shown only 304 samples were confirmed in the laboratory, this group was defined as definitive diagnosis group. POCT CRP, NLR, SI were unable to differentiate between bacterial and viral infections. However, in the definitive bacteria groups with severe bacterial infections, the POCT CRP values and SI ratio was shown to be distinctive markers. Interestingly, the levels seen in COVID-19 samples made them indistinguishable to the levels seen in the bacterial groups. The effectiveness of the clinical biomarkers was analysed using the ROC curve, the findings have shown CRP (AUC: 0.892 95 % CI 0.802-0.982) to have a p-value of <0.0001 as well as SI to have a p-value of <0.0001 (AUC: 0.840 95 % CI 0.752-0.929). However, NLR (AUC: 0.696 95% CI 0.552-0.840) had limited discriminative ability producing a p-value of 0.0075. The findings of this current study have shown the potential of CRP and SI as a diagnostic tool for paediatric sepsis however, due to the small sample size further investigation needs to be carried out.
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