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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">O diagn&#243;stico de bronquiolite aguda &#233; essencialmente cl&#237;nico&#46; A utilidade de exames laboratoriais&#44; em particular do doseamento da prote&#237;na C reactiva &#40;PCR&#41;&#44; n&#227;o est&#225; bem estabelecida&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">O objectivo deste trabalho foi avaliar a rela&#231;&#227;o entre o valor da PCR e os marcadores indirectos de gravidade em doentes com diagn&#243;stico de bronquiolite&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos no estudo todos os doentes admitidos no Servi&#231;o de Pediatria do HSJ durante o ano de 2006 e que tiveram como diagn&#243;stico principal bronquiolite&#44; tendo sido feita uma revis&#227;o retrospectiva do processo cl&#237;nico desses doentes&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 176 doentes com idades compreendidas entre zero e 36 meses &#40;mediana de 4 meses&#41;&#59; 63&#44;1&#37; eram do sexo masculino&#46; O doseamento da PCR tinha sido efectuado em 94&#44;3&#37; dos doentes&#44; com valores compreendidos entre zero e 256<span class="elsevierStyleHsp" style=""></span>mg&#47;L e com mediana de 11<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">O valor da PCR&#44; na popula&#231;&#227;o estudada&#44; apresentou uma rela&#231;&#227;o estatisticamente significativa com a admiss&#227;o em unidade de cuidados intensivos &#40;UCI&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#44; a dura&#231;&#227;o do internamento hospitalar &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; e a necessidade de oxigenoterapia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41;&#46;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Desta forma&#44; este trabalho coloca a hip&#243;tese de o valor de PCR poder ser um marcador de gravidade e ter significado progn&#243;stico em doentes com bronquiolite&#46; Mais estudos s&#227;o necess&#225;rios para validar estes resultados e esclarecer se existe uma rela&#231;&#227;o real entre as vari&#225;veis estudadas ou se esta &#233; produzida pelo efeito confundidor de outras infec&#231;&#245;es&#46;</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009&#59; XV &#40;1&#41;&#58; 55-65</span></p></span>"
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Vol. 15. Issue 1.
Pages 55-65 (January - February 2009)
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Vol. 15. Issue 1.
Pages 55-65 (January - February 2009)
Artigo Original/Original Article
Open Access
Proteína C reactiva e gravidade da bronquiolite aguda
C Reactive protein and disease severity in bronchiolitis
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S. Costa1, R. Rocha2, M. Tavares3, A. Bonito-Vítor4, L. Guedes-Vaz5
1 Interna Complementar de Pediatria, Serviço de Pediatria HSJ / Paediatrics resident, Paediatrics Department, HSJ
2 Interno Complementar de Pediatria, Serviço de Pediatria HSJ / Paediatrics resident, Paediatrics Department, HSJ
3 Assistente hospitalar de Pediatria, Serviço de Pediatria HSJ / Paediatrics consultant, Paediatrics Department, HSJ
4 Assistente hospitalar de Pediatria, Unidade de Pneumologia Pediátrica do Serviço de Pediatria HSJ / Paediatrics consultant, Paediatric Pulmonology Unit, Paediatrics Department, HSJ
5 Chefe de Serviço de Pediatria, Unidade de Pneumologia Pediátrica do Serviço de Pediatria HSJ / Head, Paediatrics, Paediatric Pulmonology Unit, Paediatrics Department HSJ
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Resumo

O diagnóstico de bronquiolite aguda é essencialmente clínico. A utilidade de exames laboratoriais, em particular do doseamento da proteína C reactiva (PCR), não está bem estabelecida.

O objectivo deste trabalho foi avaliar a relação entre o valor da PCR e os marcadores indirectos de gravidade em doentes com diagnóstico de bronquiolite.

Foram incluídos no estudo todos os doentes admitidos no Serviço de Pediatria do HSJ durante o ano de 2006 e que tiveram como diagnóstico principal bronquiolite, tendo sido feita uma revisão retrospectiva do processo clínico desses doentes.

Foram incluídos 176 doentes com idades compreendidas entre zero e 36 meses (mediana de 4 meses); 63,1% eram do sexo masculino. O doseamento da PCR tinha sido efectuado em 94,3% dos doentes, com valores compreendidos entre zero e 256mg/L e com mediana de 11mg/L.

O valor da PCR, na população estudada, apresentou uma relação estatisticamente significativa com a admissão em unidade de cuidados intensivos (UCI) (p=0,008), a duração do internamento hospitalar (p=0,025) e a necessidade de oxigenoterapia (p=0,022).

Desta forma, este trabalho coloca a hipótese de o valor de PCR poder ser um marcador de gravidade e ter significado prognóstico em doentes com bronquiolite. Mais estudos são necessários para validar estes resultados e esclarecer se existe uma relação real entre as variáveis estudadas ou se esta é produzida pelo efeito confundidor de outras infecções.

Rev Port Pneumol 2009; XV (1): 55-65

Palavras-chave:
Bronquiolite
diagnóstico
proteína C reactiva
Abstract

A diagnosis of bronchiolitis is made clinically and the use of supportive laboratory examinations, including the quantification of C reactive protein (CRP), is not well established.

The aim of this study was to evaluate the correlation between CRP value and indirect markers of disease severity in patients with bronchiolitis.

This study included the patients diagnosed with bronchiolitis admitted to the Pediatrics Department of S. João Hospital in 2006. A retrospective review was made through analysing clinical files.

176 patients aged 0 to 36 months (median of 4 months) were included. 63.1% were males. CRP level was measured in 94.3% of the patients, with values ranging from zero to 256mg/L and a median of 11mg/L.

CRP value in this population had a statistically significant relation with admission to Intensive Care Unit (ICU) (p=0.008), length of hospital stay (p=0.025) and need for supplementary oxygen during hospital stay (p=0.022).

This work raises the hypothesis that the CRP value on admission might be a marker of disease severity and have prognostic significance in patients with bronchiolitis. Further investigation is necessary to validate these results and exclude the potential confounding effect of associated infections.

Rev Port Pneumol 2009; XV (1): 55-65

Key-words:
Bronchiolitis
diagnosis
C reactive protein
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Bibliografia / Bibliography
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Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis – clinical practice guideline.
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Arch Pediatr Adolesc Med, 158 (2004), pp. 119-126
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Correlation between serum interleukine 6 and C-reactive protein concentration in patients with adenoviral respiratory infection.
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Serum procalcitonin, C-reactive protein and interleukine-6 for distinguishing bacterial and viral pneumonia in children.
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G. Garcia, M.O. Gabin, C.C. Reya, M.I. Avarez, J.A. Ruiz, et al.
Infecciones virales de vias respiratorias inferiores en lactantes hospitalizados: etiologia, caracteristicas clinicas y factores de riesgo.
An Esp Pediatr, 55 (2001), pp. 101-107
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B. Resch, C. Gusenleiner, W. Muller.
Procalcitonin, Interleukine-6, C-reactive protein and leukocyte counts in infants with bronchiolitis.
Pediatr Infect Dis J, 22 (2003), pp. 475-476
Copyright © 2009. Sociedade Portuguesa de Pneumologia/SPP
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