Use of C-Reactive Protein and Ferritin Biomarkers in Daily Pediatric Practice

Matthew D. Taylor; Vivek Allada; Michael L. Moritz; Andrew J. Nowalk; Rakesh Sindhi; Rajesh K. Aneja; Kathryn Torok; Michael J. Morowitz; Marian Michaels; Joseph A. Carcillo

doi:10.1542/pir.2018-0101

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Matthew D. Taylor, MD*
Vivek Allada, MD^†
Michael L. Moritz, MD^‡
Andrew J. Nowalk, MD, PhD^{^§}
Rakesh Sindhi, MD^¶
Rajesh K. Aneja, MD**
Kathryn Torok, MD^††
Michael J. Morowitz, MD^‡‡
Marian Michaels, MD, MPH^§
Joseph A. Carcillo, MD**

^*Division of Critical Care Medicine, Cohen Children’s Medical Center of New York, New Hyde Park, NY
^†Department of Pediatrics–Cardiology,
^‡Department of Pediatrics–Nephrology,
^§Department of Pediatrics–Infectious Diseases,
^¶Pediatric Transplant Division, Department of Surgery,
^**Department of Critical Care Medicine and Pediatrics,
^††Department of Pediatrics–Rheumatology, and
^‡‡General Pediatric Surgery Division, Department of Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA

AUTHOR DISCLOSURE
Dr Taylor has disclosed that his spouse was a consultant for Corcept Therapeutics. Dr Aneja has disclosed that he receives royalties from UpToDate (Wolters Kluwer). Dr Michaels has disclosed that she receives support from Pfizer grant funding to her institution. Dr Carcillo has disclosed that he receives support from the National Institute of Child Health and Human Development (grant NICHD GM108618) via funding paid to his institution. Drs Allada, Moritz, Nowalk, Sindhi, Torok, and Morowitz have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abstract

Recent pediatric clinical research has begun to focus on risk stratification tools using multibiomarker models. C-reactive protein (CRP) and ferriti biomarkers are widely available and used to varying degrees in daily practice, but there is no single source examining the evidence behind their use.

We set out to summarize the evidence behind the use of CRP and ferritin biomarkers in pediatric practice and to begin development of a consensus for their future use for pediatricians.

All the literature involving CRP and ferritin in pediatrics available on PubMed was surveyed. Research applicable to daily pediatric practice was summarized in the body of the article. Pediatric clinicians of various subspecialties contributed to the summary of the use of CRP and ferritin biomarkers in clinical practice in various disease processes. A clinical decision pathway is described, and evidence is summarized.

CRP and ferritin biomarkers have diverse uses with various cutoff values in the literature, making their use in daily practice difficult. Elevation of these markers coincides with their significant elevation in uncontrolled inflammation.

CRP and ferritin biomarkers are widely used in pediatrics. This review provides a resource summarizing evidence into a single source. There is sufficient evidence to indicate that these biomarkers of inflammation can be useful in guiding clinical decision making in specific clinical scenarios; however, further work is needed to improve their use in clinical practice.