Procalcitonin in pediatrics for differentiation of bacterial and viral infections

Use of Procalcitonin for Identification of Cobacterial Pneumonia in Pediatric Patients

OBJECTIVE

To evaluate the utility of procalcitonin (PCT) in identifying cobacterial pneumonia in pediatric patients with known viral respiratory infection.

METHODS

A retrospective cohort study was conducted in a stand-alone children's hospital during 2 time periods (period 1: October 1, 2014, to March 31, 2015; period 2: October 1, 2015, to March 31, 2016). Patients admitted with any upper respiratory tract infection were included. Exclusion criteria included any condition compromising lung function, age <30 days or >18 years, or lack of PCT (period 2). PCT values of <0.5 ng/mL were considered normal, whereas values of >1.5 ng/mL were used to identify cobacterial pneumonia. Receiver-operator characteristic curves were used with multiple logistic regression to evaluate patient variables.

RESULTS

Of the 374 pediatric patients evaluated, 64% were classified as having viral pneumonia and 23% as having cobacterial pneumonia across both study time periods. Non-significant predictors of cobacterial pneumonia included temperature (p = 0.0795, p = 0.1466), WBC count (p = 0.8774, p = 0.6675), and C-reactive protein (p = 0.7115, p = 0.3835). Median initial PCT for patients with viral pneumonia was 0.14 ng/mL compared with 1.41 ng/mL in patients with cobacterial pneumonia; median second PCTs were 0.26 ng/mL (viral pneumonia) and 4.55 ng/mL (cobacterial pneumonia). Patients with an elevated PCT had 17.5 times (95% CI, 5.2, 59.1) greater odds of having a cobacterial pneumonia.

CONCLUSIONS

PCT was found to be strongly associated with cobacterial pneumonia with an underlying viral etiology. Temperature, WBC, and C-reactive protein failed to be significant predictors in differentiating between viral and cobacterial pneumonia.

Procalcitonin as a useful marker to decide upon intervention for urinary tract infection

Background

Because the use of procalcitonin has been advocated as a marker of bacterial infection, this study was carried out to determine the usefulness of serum PCT as an early marker to decide upon intervention for urinary tract infection.

Methods

The subjects were 68 patients with urinary tract infection (UTI) in whom we measured serum procalcitonin concentration at the start of treatment.

Results

There were 47 patients with nonobstructed UTI and 21 with obstructed UTI. All patients with obstructed UTI were subjected to intervention. There were significant differences in procalcitonin, white blood cells, and creatinine levels between patients with nonobstructed and obstructed UTI (P < 0.05).

Conclusion

Although this retrospective study comprised a small number of patients, we found that procalcitonin was a useful marker to decide upon urinary intervention.

Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis

BACKGROUND

Early diagnosis of Acute Osteomyelitis (OM) and Septic Arthritis (SA) is of vital importance to avoid devastating complications. There is no single laboratory marker which is sensitive and specific in diagnosing these infections accurately. Total Count, ESR and CRP are not specific as they can also be elevated in non pyogenic causes of inflammation. Pus Culture and sensitivity is not a true gold standard due to its varied positivity rates (40 - 70%). Serum Procalcitonin (PCT), at 0.5 ng/ml is found to be an accurate marker for pyogenic infections. The objectives of this study were to show that PCT is an accurate marker in differentiating Acute Osteomyelitis and Septic Arthritis from viral and non infective inflammatory bone and joint conditions.

METHODS

Patients of all age groups (n = 82) with suspected Acute Osteomyelitis and Septic Arthritis were prospectively included in this study. All patients were subjected to TC, CRP, PCT, IgM Dengue, IgM Chikungunya, pus and blood culture and sensitivity. At the end of the study, patients were classified into 3 groups: Group 1 = Confirmed Pyogenic (n = 27); Group 2 = Presumed Pyogenic (n = 21); Group 3 = Non - infective inflammatory (n = 34).

RESULTS

Group 1 has higher mean PCT levels than Group 2 and 3 (p < 0.05). PCT, at 0.4 ng/ml, was 85.2% sensitive and 87.3% specific in diagnosing Septic Arthritis and Acute Osteomyelitis. In comparison, PCT at conventional cut - off of 0.5 ng/ml is 66.7% sensitive and 91% specific.

CONCLUSION

Serum Procalcitonin, at a cut - off of 0.4 ng/ml, is a sensitive and specific marker in the diagnosis of Septic Arthritis and Acute Osteomyelitis.

Procalcitonin as an indicator of urosepsis

Background

Procalcitonin has been advocated as a marker of bacterial infection, so this study was carried out to determine the usefulness of serum procalcitonin in the early diagnosis of urosepsis.

Methods

The subjects were 37 febrile patients with urinary tract infection in whom we examined the serum procalcitonin concentration at the start of treatment.

Results

Thirty patients had acute pyelonephritis (16 simple, 14 complex), one had emphysematous pyelonephritis, five had acute prostatitis, and one had acute epididymitis. The procalcitonin level was <0.5 ng/mL in 18 patients, ≥0.5 ng/mL in one patient, ≥2 ng/mL in seven patients, and ≥10 ng/mL in 11 patients. Five of the 11 patients with procalcitonin levels ≥ 10 ng/mL had disseminated intravascular coagulation. All patients with urinary tract obstruction and disseminated intravascular coagulation had procalcitonin levels ≥ 10 ng/mL.

Conclusion

Although this retrospective study comprised a small number of patients, we found that procalcitonin was a useful marker for urinary tract infection.

Evaluation of serum procalcitonin levels for diagnosis of secondary bacterial infections in visceral leishmaniasis patients

Abstract. Secondary bacterial infections are a major complication and cause of death in children with visceral Leishmaniasis (VL). Thus, early diagnosis of bacterial infections is an important step in the treatment of patients with VL. The goal of this study was to determine if serum procalcitonin (PCT) could be used as a diagnostic marker of secondary bacterial infections in VL patients. Serum PCT was measured in 35 hospitalized patients with VL before treatment and after defervescence. The level was higher than normal (> 0.5 ng/mL) in 72% (25) of the patients. Twelve (34%) of 35 patients had secondary bacterial infections with PCT levels ranging from 0.1 to 12.29 ng/mL, and those without secondary bacterial infections (23) had PCT levels ranging from 0.1 to 14.58 ng/mL. The results suggest that PCT levels increase significantly in most VL patients but are not correlated with the presence of secondary bacterial infections.

Immune regulation of procalcitonin: a biomarker and mediator of infection

Procalcitonin (PCT) has recently emerged as a powerful biomarker for an early and accurate diagnosis of bacterial infection. Here we summarize our current understanding of the expression pathways of PCT, its potential cellular sources including immune cells, and factors inducing its secretion. Also addressed is the significance of increased blood PCT concentration, which may allow this molecule not only to act as a clinical biomarker but also as an active participant in the development and progression of infectious processes. Experimental approaches to delineate a better understanding of PCT functions, molecular pathways that modulate its expression and therapeutic opportunities to curtail its biological actions are discussed, as well.

The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

OBJECTIVES

During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients with suspected 2009 Influenza A H1N1 infection.

METHODS

The serum levels of procalcitonin, C-reactive protein, tumor necrosis factor α, interferon γ, interleukin 1β, and interleukin 10 were tested on admission and on days 3, 5, and 7 in 35 patients with suspected 2009 H1N1 infection who were admitted to two ICUs.

RESULTS

Twelve patients had confirmed 2009 influenza A H1N1 infections, 6 had seasonal influenza infections, and 17 patients had negative swabs. The procalcitonin levels at inclusion and on day 3, and the C-reactive protein levels on day 3 were higher among subjects with 2009 influenza A H1N1 infections. The baseline levels of interleukin 1b were higher among the 2009 influenza A H1N1 patients compared with the other groups. The C-reactive protein levels on days 3, 5, and 7 and procalcitonin on days 5 and 7 were greater in non-surviving patients.

CONCLUSION

Higher levels of procalcitonin, C-reactive protein and interleukin-1β might occur in critically ill patients who had a 2009 H1N1 infection. Neither procalcitonin nor CRP were useful in discriminating severe 2009 H1N1 pneumonia. Higher levels of CRP and procalcitonin appeared to identify patients with worse outcomes.

Secretory phospholipase A2: a marker of infection in febrile children presenting to a pediatric ED

BACKGROUND

Fever is a common presenting complaint to the emergency department (ED), and the evaluation of the febrile child remains a challenging task.

OBJECTIVE

The aim of this study was to examine the relationship between secretory phospholipase A2 (sPLA2) and infection in febrile children.

METHODS

A prospective convenience sample of children presenting with fever to an urban pediatric ED were studied. Blood and urine cultures, a complete blood count, and serum concentrations of sPLA2 were obtained, and patients were compared based on their final diagnosis of either a viral or bacterial infection.

RESULTS

In the 76 patients enrolled, 60 were diagnosed with a viral infection, 14 with a bacterial infection, 1 with Kawasaki disease, and 1 with acute lymphoblastic leukemia. The difference in the serum concentration of sPLA2 in patients with viral infections (22 ± 34 ng/mL) versus those with bacterial infections (190 ± 179 ng/mL) was statistically significant (P < .0001). Receiver operator characteristic curve analysis revealed that sPLA2 was more accurate at predicting bacterial infection (area under the curve = 0.89) than the total white blood cell count (area under the curve = 0.71) and that a value of more than 20 ng/mL had a sensitivity of 93%, specificity of 67%, positive predictive value of 39%, and negative predictive value of 97%.

CONCLUSION

Secretory phospholipase A2 differs significantly in children with viral versus bacterial infection and seems to be a reliable screening test for bacterial infection in febrile children.

Usefulness of procalcitonin serum level for the discrimination of severe sepsis from sepsis: a multicenter prospective study

Procalcitonin serum level has been recommended as a new marker of bacterial infectious diseases. The aim of this prospective, multicenter study was to determine the clinical usefulness of procalcitonin in differentiating patients with sepsis from those with severe sepsis. Eighty-two patients were enrolled: 20 without systemic inflammatory response syndrome (SIRS), 9 with SIRS, 34 with sepsis, and 19 with severe sepsis. The patients with severe sepsis had significantly higher procalcitonin levels (median, 36.1 ng/ml) than those with sepsis (median, 0.6 ng/ml). With a procalcitonin cutoff value of 2.0 ng/ml, sensitivity for the detection of severe sepsis and specificity for the detection of sepsis were 94.7% and 78.1%, respectively. A good correlation was found between the serum procalcitonin level and the Sepsis-Related Organ Failure Assessment (SOFA) score (r = 0.680), although no correlation was found between the C-reactive protein (CRP) level and the SOFA score. In conclusion, the procalcitonin serum level may be useful not only for aiding the diagnosis of sepsis but also for discriminating between sepsis and severe sepsis.