Correlation Study Between C-Reactive Protein, Procalcitonin with Hematological Parameters Of Children with Pyrexia of Unknown Origin (PUO) in Karbala Pediatric Teaching Hospital

  • Ali Abdulrazzaq Karbala Pediatric Teaching Hospital / Karbala Health Directorate
  • Ahmed Salim Hadi Al-Khafaji Karbala Pediatric Teaching Hospital / Karbala Health Directorate
  • Nihad Khalawe Tektook Middle Technical University / College of Medical &Health Technology, Medical laboratory techniques dep. / Iraq
Keywords: Fever, PCR, CRP, PUO, Children


A case control hospital based selective study was done on 100 children with PUO who admitted to the Karbala Pediatric Teaching Hospital in Karbala city, during the period from 1st of March 2018 to the last of March 2019 aged from 2 months-5 years. A comparable group of similar number of cases of apparently healthy children was taken as a control group. This study aimed to evaluate the diagnostic value of CRP and PCT pyrogenic of unknown origin (PUO) in relation to some hematological parameters. The study included the collection of 3 ml of blood from each patient and control for assessment of PCT and CRP by immunofluorescence and hematological parameters by general auto-analyzer hematology. This case control study included 100 children with PUO (60 males and 40 females), their age range was 3-48 months (mean: 17.12±8.2 month), the study also included 100 healthy children (as control group) with the same characteristics of the patient. The study revealed that the highest mean level of PCT was recorded among children with PUO (17.36 ng/ml) and the lowest level mean level was found in healthy children (3.56 ng/ml). The study also exposed that the highest mean level of CRP was recorded among children with PUO (22.6 ng/ml) and the lowest level mean level was found in healthy children (2.11 ng/ml). The study showed that WBCs, neutrophils and lymphocytes counts were elevated significantly among children with PUO as compared with healthy children. The study revealed a significant positive correlation between PCT and CRP among children with PUO (r: 0.84, P<0.001), and a significant positive correlation of  PCT and CRP with each of WBCs, neutrophils and lymphocytes counts among children with PUO. It was concluded that there a significant positive correlation between PCT and CRP and significant positive correlation of  PCT and CRP with each of WBCs, neutrophils and lymphocytes counts among children  with PUO


Halder R, Seth T, Chaturvedi PK, Mishra P, Mahapatra M, Pati HP, Tyagi S, Saxena R. Comparison of CRP and procalcitonin for etiological diagnosis of fever during febrile neutropenia in hematology patients-an experience from a tertiary care center in Northern India. Blood Cells, Molecules, and Diseases. 2020 May 14:102445.

Sharland M, Butler K, Cant A, Dagan R, Davies G, de Groot R, Elliman D, Esposito S, Finn A, Galanakis M, Giaquinto C, editors. Manual of childhood infections: the blue book. Oxford University Press; 2016 Apr 7.

Carroll J, Klein N. Clinical manual of fever in children. Springer; 2019.

Phillips RS. Optimizing risk predictive strategies in febrile neutropenic episodes in children and young people undergoing treatment for malignant disease (Doctoral dissertation, University of York).

Ludwig DR, Amin TN, Manson JJ. Suspected systemic rheumatic diseases in adults presenting with fever. Best Practice & Research Clinical Rheumatology. 2019 Aug 1;33(4):101426.

Kallio R, Surcel HM, Bloigu A, Syrjälä H. C-reactive protein, procalcitonin and interleukin-8 in the primary diagnosis of infections in cancer patients. European Journal of Cancer. 2000 May 1;36(7):889-94.

Kucukgoz Gulec U, Tuncay Ozgunen F, Baris Guzel A, Buyukkurt S, Seydaoglu G, Ferhat Urunsak I, Cuneyt Evruke I. An analysis of C‐reactive protein, procalcitonin, in PUO patients. American journal of reproductive immunology. 2012 Oct;68(4):331-7.

Schrag B, Roux-Lombard P, Schneiter D, Vaucher P, Mangin P, Palmiere C. Evaluation of C-reactive protein, procalcitonin, tumor necrosis factor alpha, interleukin-6, and interleukin-8 as diagnostic parameters in sepsis-related fatalities. International journal of legal medicine. 2012 Jul 1;126(4):505-12.

Claessens YE, Mathevon T, Kierzek G, Grabar S, Jegou D, Batard E, Loyer C, Davido A, Hausfater P, Robert H, Lavagna-Perez L. Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia. Intensive care medicine. 2010 May 1;36(5):799-809.

Nijman RG, Moll HA, Smit FJ, Gervaix A, Weerkamp F, Vergouwe Y, de Rijke YB, Oostenbrink R. C-reactive protein, procalcitonin and the lab-score for detecting serious bacterial infections in febrile children at the emergency department: a prospective observational study. The Pediatric infectious disease journal. 2014 Nov 1;33(11):e273-9.

Gendrel D, Raymond J, Coste J, Moulin F, Lorrot M, Guerin S, Ravilly S, Lefevre H, Royer C, Lacombe C, Palmer P. Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentiation of bacterial vs. viral infections. The Pediatric infectious disease journal. 1999 Oct 1;18(10):875-81.

Groselj-Grenc M, Ihan A, Pavcnik-Arnol M, Kopitar AN, Gmeiner-Stopar T, Derganc M. Neutrophil and monocyte CD64 indexes, lipopolysaccharide-binding protein, procalcitonin and C-reactive protein in sepsis of critically ill neonates and children. Intensive care medicine. 2009 Nov 1;35(11):1950.

Toikka P, Irjala K, Juven T, Virkki R, Mertsola J, Leinonen M, Ruuskanen O. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. The Pediatric infectious disease journal. 2000 Jul 1;19(7):598-602.

Uusitalo-Seppälä R, Koskinen P, Leino A, Peuravuori H, Vahlberg T, Rintala EM. Early detection of severe sepsis in the emergency room: diagnostic value of plasma C-reactive protein, procalcitonin, and interleukin-6. Scandinavian journal of infectious diseases. 2011 Dec 1;43(11-12):883-90.

Kofoed K, Andersen O, Kronborg G, Tvede M, Petersen J, Eugen-Olsen J, Larsen K. Use of plasma C-reactive protein, procalcitonin, neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study. Critical care. 2007 Apr 1;11(2):R38.

Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. The Pediatric infectious disease journal. 2007 Aug 1;26(8):672-7.

Christ-Carin M. Procalcitonin in bacterial infections-hype, hope, more or less?. Swiss Medical Weekly 2009;135:451-60.

Charles PE, Ladoire S, Aho S, et al. Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria. BMC Infectious Disease 2008;8:38-42.

Vorwerk C, Loryman B, Coats TJ, et al. Prediction of mortality in adult emergency department patients with sepsis. Emergency Medicine Journal 2009;26(4):254-8.

Peters RP, Twisk JW, van Agtmael MA, Groeneveld AJ. The role of procalcitonin in a decision tree for prediction of bloodstream infection in febrile patients. Clinical Microbiology and Infection 2006;12(12):1207-13.

Nylen E, Müller B, Becker KL, et al. The future diagnostic role of procalcitonin: the need for improved sensitivity. Clinical Infectious Diseases 2003;36:823–7.

Müller B, Christ-Crain M, Nylen E, et al. Limits to the use of procalcitonin level as a diagnostic marker. Clinical Infectious Diseases 2004;39:1867–70.

Schuetz P, Mueller B, Trampuz A. Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative staphylococci. Infection 2007;35(5):352.