Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old
Mahajan, Prashant; Grzybowski, Mary; Chen, Xinguang; Kannikeswaran, Nirupama; Stanley, Rachel; Singal, Bonita; Hoyle, John; Borgialli, Dominic; Duffy, Elizabeth; Kuppermann, Nathan
2014-02
Citation
Mahajan, Prashant; Grzybowski, Mary; Chen, Xinguang; Kannikeswaran, Nirupama; Stanley, Rachel; Singal, Bonita; Hoyle, John; Borgialli, Dominic; Duffy, Elizabeth; Kuppermann, Nathan (2014). "Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old." Academic Emergency Medicine (2): 171-179.
Abstract
Objectives There is no perfectly sensitive or specific test for identifying young, febrile infants and children with occult serious bacterial infections ( SBI s). Studies of procalcitonin ( PCT ), a 116‐amino‐acid precursor of the hormone calcitonin, have demonstrated its potential as an acute‐phase biomarker for SBI . The objective of this study was to compare performance of serum PCT with traditional screening tests for detecting SBI s in young febrile infants and children. Methods This was a prospective, multicenter study on a convenience sample from May 2004 to December 2005. The study was conducted in four emergency departments ( ED s): one pediatric ED and three ED s with pediatric units, all with academic faculty on staff. A total of 226 febrile children 36 months old or younger who presented to the four participating ED s and were evaluated for SBI by blood, urine, and/or cerebral spinal fluid ( CSF ) cultures were included. Results The test characteristics (with 95% confidence intervals [CIs]) of the white blood cell (WBC) counts including neutrophil and band counts were compared with PCT for identifying SBI. Thirty children had SBIs (13.3%, 95% CI = 8.85 to 17.70). Four (13.3%) had bacteremia (including one with meningitis), 18 (60.0%) had urinary tract infections (UTIs), and eight (26.6%) had pneumonia. Children with SBIs had higher WBC counts (18.6 × 10 9 ± 8.6 × 10 9 cells/L vs. 11.5 × 10 9 ± 5.3 × 10 9 cells/L, p < 0.001), higher absolute neutrophil counts (ANCs; 10.6 × 10 9 ± 6.7 × 10 9 cells/L vs. 5.6 × 10 9 ± 3.8 × 10 9 cells/L, p = 0.009), higher absolute band counts (0.90 × 10 9 ± 1.1 × 10 9 cells/L vs. 0.35 × 10 9 ± 0.6 × 10 9 cells/L, p = 0.009), and higher PCT levels (2.9 ± 5.6 ng/ mL vs. 0.4 ± 0.8 ng/ mL , p = 0.021) than those without SBIs. In a multivariable logistic regression analysis, the absolute band count and PCT were the two screening tests independently associated with SBI, although the area under the receiver operating characteristic (ROC) curve for PCT was the largest (0.80, 95% CI = 0.71 to 0.89). Conclusions Procalcitonin is a more accurate biomarker than traditional screening tests for identifying young febrile infants and children with serious SBI s. Further study on a larger cohort of young febrile children is required to definitively determine the benefit of PCT over traditional laboratory screening tests for SBI s. Resumen Objetivos No existe un test con la sensibilidad o especificidad ideal es para identificar las infecciones bacterianas graves ( IBG ) ocultas en los niños durante su primera infancia con fiebre. Los estudios de procalcitonina ( PCT ), un precursor de 116‐aminoácidos de la hormona calcitonina, han demostrado su potencial como biomarcador de fase aguda para las IBG . El objetivo de este estudio es comparar el rendimiento de la PCT en plasma con las pruebas de despistaje tradicionales para la detección de IBG en los niños durante la primera infancia con fiebre. Metodología Estudio prospectivo multicéntrico en una muestra de conveniencia realizado de mayo de 2004 a diciembre realizado de 2005. Este estudio se llevó a cabo en cuatro servicios de urgencias ( SU ): un SU pediátrico y tres SU con unidades pediátricas, todos ellos con docentes universitarios en la plantilla. Se incluyeron 226 niños de 0 a 36 meses de edad con fiebre que acudieron a los cuatro SU participantes y se les evaluó para IBG mediante cultivos de sangre, orina y/o líquido cefalorraquídeo. Resultados Los resultados (con los intervalos de confianza [IC] al 95%) del número de leucocitos, incluyendo número neutrófilos y blastos, y de la PCT se compararon para identificar las IBG. Treinta niños tuvieron IBG (13,3%, IC 95% = 8,85 a 17,70). Cuatro (13,3%) tuvieron bacteremia (incluyendo uno con meningitis), 18 (60,0%) infección del tracto urinario y 8 (26,6%) neumonía. Los niños con IBG tuvieron mayor número de leucocitos (18.600 ± 8.600 cel/mm 3 vs. 11.500 ± 5.300 cel/mm 3 , p< 0,001), número absoluto de neutrófilos (NAN) (10.600 ± 6.700 cel/mm 3 vs. 5.600 ± 3.800 cel/mm 3 , p = 0,009), número absoluto de blastos (900 ± 1.100 cel/mm 3 vs. 350 ± 600 cel/mm 3 , p = 0,009) y valores de PCT (2,9 ng/ mL ± 5,6 ng/ mL vs. 0,4 ng/ mL ± 0,8 ng/ mL , p = 0,021), que aquéllos sin IBG. En un análisis multivariable de regresión logística, el número absoluto de blastos y la PCT fueron los dos test de despistaje que se asociaron de forma independiente con IBG, aunque el área bajo la curva de rendimiento diagnóstico para la PCT fue la mayor de los test de despistaje (0,80, IC 95% = 0,71 a 0,89). Conclusiones La PCT es un biomarcador más preciso que las pruebas de despistaje tradicionales para identificar a los niños durante la primera infancia con IBG . Se requieren futuros estudios en una mayor cohorte de niños durante la primera infancia con fiebre para determinar de forma definitiva el beneficio de la PCT sobre las pruebas de despistaje de laboratorio tradicionales para identificar las IBG .Publisher
Wiley Periodicals, Inc. Brahms Diagnostica
ISSN
1069-6563 1553-2712
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