Procalcitonin Levels in Critically Ill Children With Status Asthmaticus

Area of Science:

• Pediatric Critical Care Medicine
• Infectious Disease Diagnostics
• Respiratory Medicine

Background:

• Children with status asthmaticus (SA) often present with fever and undergo chest radiography (CXRs).
• Antibiotics are frequently administered based on radiological findings or suspected pneumonia, lacking definitive bacterial infection markers.
• Serum procalcitonin (PCT) is a biomarker investigated for bacterial infection, but its utility in pediatric SA is unclear.

Purpose of the Study:

• To investigate serum PCT levels in critically ill children admitted with SA.
• To determine if PCT levels correlate with radiological infiltrates or antibiotic treatment in pediatric SA.

Main Methods:

• A prospective, single-center observational study included 61 children (1-21 years) with SA admitted to the pediatric intensive care unit (PICU).
• Serum PCT levels were measured at admission.
• Patients were categorized based on radiological bacterial pneumonia (radiologist-confirmed) and clinician-diagnosed pneumonia (physician-treated with antibiotics).

Main Results:

• The mean PCT level was 0.65 ng/mL (median 0.3 ng/mL).
• No significant difference in PCT levels was observed between patients with and without clinician-diagnosed pneumonia (P = 0.44).
• A PCT cutoff of 0.5 ng/mL was associated with fever (P = 0.004) but not with CXR infiltrates, radiological pneumonia, or antibiotic use.

Conclusions:

• Serum PCT levels were not elevated above 0.5 ng/mL in 75% of critically ill children with SA.
• Chest X-ray infiltrates did not correlate with higher PCT levels in this cohort.
• Larger clinical trials are necessary to establish the diagnostic and predictive value of PCT in pediatric SA.