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Salivary C-reactive protein—a possible predictor of serum levels in pediatric acute respiratory illness

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Abstract

Identifying the etiology of an acute respiratory infection in children is a well-known challenge. In this study, we evaluated the correlation between salivary C-reactive protein (CRP) and its serum counterpart, which is known to be higher in bacterial infections but necessitates a venipuncture. Salivary and serum CRPs were measured in children with an acute respiratory illness, aged 2 months to 18 years. Pearson’s correlation coefficients were used to measure correlation. Discrimination of the salivary CRP levels for predicting serum levels above 100 mg/L was calculated and compared to serum CRP levels. Sensitivity and specificity were similarly calculated. Salivary CRP was measured in 104 samples. Levels correlated significantly and positively with serum CRP levels (r = 0.670, p<0.001). Area under the curve for predicting serum CRP levels of 100 mg/L was 0.848. For a salivary CRP concentration above 32,610 ng/L, the sensitivity and specificity were 69% and 93%, respectively, for accurately predicting a serum CRP level ≥100 mg/L.

Conclusions: Salivary CRP can be used in the pediatric acute setting due to its high specificity for predicting elevated serum levels without the need for venipuncture. Further studies are required to achieve higher sensitivity rates.

What is known:

• Salivary C-reactive protein has shown correlation to its serum counterpart, mainly in healthy children, adults, and ill neonates.

What is new:

• In a large population of children with acute respiratory illness, aged 2 months to 18 years, salivary C-reactive protein showed high specificity for predicting elevated serum levels, thus indicating its potential as a diagnostic tool.

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Availability of data and material

All data and materials support our claims in the manuscript. Limitations found in the data were mentioned in the text.

Code availability

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Abbreviations

CRP:

C-reactive protein

IQR:

Interquartile range

ROC:

Receiver–Operator Characteristic

AUC:

Area Under the Curve

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Acknowledgements

The author would like to thank Tal Shaar-Gofin for her support and for providing motivation throughout this study, bringing it to its completion.

Funding

This study was supported by the “Oriki grant” and by a grant from “The Major Udi Winter Endowment Fund” (local hospital grants). RF and OZS are supported by the Simms/Mann Foundation.

Author information

Authors and Affiliations

  1. Schneider Children’s Medical Center, 14 Kaplan St., Petah Tikva, Israel

    Yoel Gofin, Eliana Fanous, Yehonatan Pasternak, Zafnat Prokocimer, Orith Waisbourd-Zinman, Sophia Fried & Gilat Livni

  2. Sackler Faculty of Medicine, Tel Aviv University, 35 Klachkin St., Tel Aviv, Israel

    Yehonatan Pasternak, Gabriel Codick, Orith Waisbourd-Zinman, Sophia Fried & Gilat Livni

  3. Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, 8 Ha’universita St., Herzliya, Israel

    Orna Zagoory-Sharon & Ruth Feldman

  4. Epidemiology & Database Research Department, Maccabi Healthcare Services, 27 Hamered St., Tel Aviv, Israel

    Gabriel Codick

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  1. Yoel Gofin
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Yoel Gofin, Eliana Fanous, Yehonatan Pasternak, Zafnat Prokocimer, and Gilat Livni. Analysis was performed by Yoel Gofin, Orna Zagoory-Sharon, Ruth Feldman, Gabriel Codick, Orith Waisbourd-Zinman, and Sophia Fried. The first draft of the manuscript was written by Yoel Gofin with critical review by Gilat Livni, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yoel Gofin.

Ethics declarations

Ethics approval

The study was approved by the local Internal Review Board at the Rabin/Schneider Medical Center. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

Freely given, informed consent to participate in the study was obtained from parents/legal guardians of all participants.

Consent for publication

Freely given, informed consent to publish study data was obtained from parents/legal guardians of all participants.

Conflict of interest

The authors declare no competing interests.

Role of Funder/Sponsor (If Any)

Resources from the funds were used for the purchase of saliva collection and analyzing equipment. The funders had no part in the study design or analysis.

Additional information

Communicated by Nicole Ritz

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Supplementary information

Supplementary Table 1

Five reserved samples underwent four freeze-thaw cycles and were measured by the same salivary CRP kit. Coefficient of variance was calculated using the formula (100XSD)/Average. (PDF 73 kb)

Supplementary Table 2

Thirty-three saliva samples were tested by two different kits on different days. CRP values were averaged. Coefficient of variance was calculated using the formula (100Xstandard deviation)/average. (PDF 92 kb)

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Gofin, Y., Fanous, E., Pasternak, Y. et al. Salivary C-reactive protein—a possible predictor of serum levels in pediatric acute respiratory illness. Eur J Pediatr 180, 2465–2472 (2021). https://doi.org/10.1007/s00431-021-04047-6

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