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Diagnostic value of procalcitonin in well-appearing young febrile infants
Borja Gomez1, Silvia Bressan, Santiago Mintegi
1Pediatric Emergency Department, Cruces Univeristy Hospital, Plaza de Cruces, 48.902 Barakaldo, Spain. borja.gomezcortes@osakidetza.net
Insights
Procalcitonin (PCT) is a valuable biomarker for identifying serious bacterial infections in febrile infants under 3 months. This study shows PCT is superior to C-reactive protein (CRP) in diagnosing invasive bacterial infections (IBIs) in this age group.
Area of Science:
- Pediatric Infectious Diseases
- Biomarker Research
- Clinical Diagnostics
Background:
- Procalcitonin (PCT) is increasingly used in European protocols for managing febrile children.
- The diagnostic utility of PCT in young, well-appearing infants with fever without source (FWS) requires further definition.
Purpose of the Study:
- To evaluate the performance of PCT in diagnosing serious bacterial infections, specifically invasive bacterial infections (IBIs).
- To compare PCT with C-reactive protein (CRP) in well-appearing infants aged less than 3 months presenting with FWS.
Main Methods:
- Retrospective analysis of 1112 infants (<3 months) with FWS from 7 European pediatric emergency departments.
- IBI defined by positive blood or cerebrospinal fluid cultures.
- Multivariate analysis including PCT, CRP, and clinical data.
Main Results:
- IBI was diagnosed in 2.1% of infants.
- PCT (≥0.5 ng/mL) was the sole independent predictor of IBI (OR 21.69).
- PCT demonstrated superior diagnostic accuracy compared to CRP, particularly in ruling out IBIs and in infants with normal urine dipstick results.
Conclusions:
- PCT is a highly effective biomarker for identifying IBIs in well-appearing infants with FWS.
- PCT outperforms CRP in diagnosing IBIs and is the most accurate blood test for ruling out infections in this population.
- PCT is the most accurate blood test for ruling out IBIs in infants with normal urine dipstick results and recent onset fever.
Background And Objective:
Procalcitonin (PCT) has been introduced in many European protocols for the management of febrile children. Its value among young, well-appearing infants, however, is not completely defined. Our objective was to assess its performance in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) in well-appearing infants aged <3 months with fever without source (FWS).
Methods:
Well-appearing infants aged <3 months with FWS admitted to 7 European pediatric emergency departments were retrospectively included. IBI was defined as the isolation of a bacterial pathogen in blood or cerebrospinal fluid culture.
Results:
We included 1112 infants who had PCT measured and a blood culture performed. IBI was diagnosed in 23 cases (2.1%). In the multivariate analysis including clinical and laboratory data, PCT was the only independent risk factor for IBI (odds ratio 21.69; 95% confidence interval [CI] 7.93-59.28 for PCT ≥ 0.5 ng/mL). Positive likelihood ratios for PCT ≥ 2 ng/mL and C-reactive protein (CRP) >40 mg/L were 11.14 (95% CI 7.81-15.89) and 3.45 (95% CI 2.20-5.42), respectively. Negative likelihood ratios for PCT <0.5 ng/mL and CRP <20 mg/L were 0.25 (95% CI 0.12-0.55) and 0.41 (95% CI 0.22-0.76). Among patients with normal urine dipstick results and fever of recent onset, areas under the receiver operator characteristic curve for PCT and CRP were 0.819 and 0.563, respectively.
Conclusions:
Among well-appearing young infants with FWS, PCT performs better than CRP in identifying patients with IBIs and seems to be the best marker for ruling out IBIs. Among patients with normal urine dipstick results and fever of recent onset, PCT remains the most accurate blood test.
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