Recovery from childhood community-acquired pneumonia in a developing country: Prognostic value of serum procalcitonin
Taiane S Fonseca1, Ângela G Vasconcellos1, Dominique Gendrel2
1Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil.
Insights
Serum procalcitonin levels can predict treatment response in childhood pneumonia. A level below 0.25 ng/ml indicates a rapid recovery and suggests a non-pneumococcal cause, aiding clinical decisions.
Area of Science:
- Biochemistry
- Pediatrics
- Infectious Diseases
Background:
- Childhood community-acquired pneumonia is a significant health concern in developing nations.
- Early identification of prognostic markers is crucial for effective antibiotic treatment.
Purpose of the Study:
- To evaluate the prognostic capability of serum procalcitonin levels upon admission.
- To correlate procalcitonin levels with clinical response to antibiotic therapy in pediatric pneumonia.
Main Methods:
- Analysis of serum procalcitonin levels in 89 children diagnosed with community-acquired pneumonia.
- Categorization of infections into viral, typical bacterial, atypical bacterial, and probable pneumococcal types.
- Assessment of clinical response based on fever resolution within 48 hours of antibiotic treatment.
Main Results:
- Children with slower clinical response (febrile after 48h) had higher admission serum procalcitonin levels (median 2.1 ng/ml vs 0.6 ng/ml).
- Pneumococcal infections were more prevalent in slow-responding children (71% vs 17%) and associated with higher procalcitonin levels (median 2 ng/ml vs 0.5 ng/ml).
- Serum procalcitonin <0.25 ng/ml demonstrated a high negative predictive value (93%) for pneumococcal infection and predicted rapid clinical recovery.
Conclusions:
- Serum procalcitonin is a valuable prognostic marker in childhood pneumonia.
- A low admission procalcitonin level (<0.25 ng/ml) predicts a rapid clinical response and a non-pneumococcal etiology.
- This marker can assist clinicians in developing countries in guiding antibiotic treatment decisions.
Background:
Childhood community-acquired pneumonia is a common and potentially life-threatening illness in developing countries. We assessed the prognostic value of serum procalcitonin level upon admission on clinical response to antibiotic treatment.
Methods:
Out of 89 patients, the median (IQR) age was 19(12-29) months and 60% were boys. Viral (49.5%), typical bacterial (38%) and atypical bacterial (12.5%) infections as well as probable pneumococcal infections (26%) were diagnosed.
Results:
Seventy-five (84%) children became afebrile ≤48h after treatment. In 14 children who remained febrile after 48h of treatment, median[IQR] serum procalcitonin (ng/ml) level on admission was higher than in those with rapid recovery (2.1[0.8-3.7] vs 0.6[0.1-2.2]; P=0.025). In the slow-responding children, pneumococcal infections were more common (71% vs 17%; P<0.001). Procalcitonin concentrations on admission were higher in children with pneumococcal pneumonia compared to children with non-pneumococcal pneumonia (2[0.7-4.2] vs 0.5[0.08-2.1]; P=0.002). The ROC curve found that <0.25ng/ml of serum procalcitonin had a high negative predictive value (93%[95%CI:80%-99%]) for pneumococcal infection. All children that remained febrile after 48h of treatment had procalcitonin >0.25ng/ml on admission. The majority of children with pneumonia in a developing country become afebrile within 48h after onset of antibiotic treatment.
Conclusions:
Serum procalcitonin <0.25ng/ml predicted rapid clinical response and non-pneumococcal etiology.
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