DISCUSSION
This study evaluated the association between CRP levels and measures of
disease severity in infants who were hospitalized due to acute RSV
bronchiolitis. The findings revealed that infants with elevated CRP
levels were older, had lower MOS, longer LOS, and higher rates of
secondary infections such as pneumonia, UTI, and AOM. Additionally,
there were more likely to receive antibiotics and require
hospitalization in the PICU. The study also proposes cutoff values for
CRP that could predict the likelihood of UTI, pneumonia, and PICU
admission.
The mean age of the children was 6.7 months, with a male predominance,
and most were term infants, while 10.8% were born prematurely. These
results align with previous medical literature regarding the demographic
characteristics of pediatric patients with RSV bronchiolitis and those
treated at the SUMC. Younger age is a known risk factor for severity in
RSV, and indeed older age was a protective factor, according to the
regression model. A relative immaturity of the immune system, supported
by studies that demonstrate a severe RSV infection associated with lower
levels of Interferon-gamma (IFN-γ) and lower fever due to inappropriate
inflammatory response, could explain a more severe course of the disease
in younger children. Our study revealed a significant correlation
between elevated CRP and older children (rather than younger children),
indicating the independent role of CRP in association with more severe
disease. This finding is further supported by the lack of influence of
prematurity and gestational age, which are prominent risk factors for
severe disease, on CRP as a severity marker. This holds true even for
premature infants under 35 weeks who routinely receive Palivizumab
during RSV season. Additionally, we observed equal distribution of CRP
levels, sex, and ethnicity in both the higher and lower CRP groups.