In a multicentre prospective study, 124 cases of meningococcal disease were classified into the clinical categories, meningitis alone (n = 15), meningitis and septicaemia (n= 79) and septicaemia alone (n = 30). A further 60 children referred with other illnesses
served as controls. Serial measurements of serum C‐reactive protein (admission, day 1, day 2, days 5–7) were compared. Children with septicaemia had significantly lower C‐reactive protein levels on admission than those with meningitis alone or meningitis and septicaemia
which were unexplained by differences in the duration of the presenting illness or severity of the disease. Within each clinical category of meningococcal disease, significant changes in C‐reactive protein concentration occurred during the course of the disease. Four control children
had other types of septic meningitis: admission C‐reactive protein concentrations did not differ from those with meningitis or meningitis and septicaemia, but were significantly higher than those with septicaemia alone. The other 56 patients had a significantly lower admission C‐reactive
protein concentration compared with all cases of meningococcal disease. For the diagnosis of meningococcal disease, admission C‐reactive protein levels of
40 mg/l had a sensitivity of 79%, specificity of 80% and positive predictive value of 87%. For the prognostic prediction of death in meningococcal disease (or meningococcal disease with shock) CRP < 100 mg/l on admission had a sensitivity of 69% (69%), specificity of 50% (56%) and positive
predictive value of 18% (53%). In children with suspected meningococcal disease, serum C‐reactive protein, measured on admission, has diagnostic value but not prognostic value. The C‐reactive protein concentration on admission varies with the clinical category of meningococcal
disease and the day of illness.
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Document Type: Research Article
Institute of Child Health, Royal Liverpool Children's Hospital. Alder Hey
Department of Biochemistry, Royal Liverpool Children's Hospital, Myrtle St.
Department of Medical Microbiology, University of Liverpool, Liverpool, UK
October 1, 1993