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Published on: February 14, 2019
Biomarkers and Disease Severity in Children With Community-Acquired Pneumonia
Todd A Florin1, Lilliam Ambroggio2, Cole Brokamp3,4
1Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; taflorin@luriechildrens.org.
Insights
In children with community-acquired pneumonia (CAP), common biomarkers like white blood cell (WBC) count and C-reactive protein (CRP) do not reliably predict severe disease. However, CRP and procalcitonin show potential for identifying the most critical outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Biomarker Research
- Clinical Diagnostics
Background:
- Community-acquired pneumonia (CAP) is a significant pediatric illness.
- Host biomarkers are used to predict disease severity in adults with CAP.
- The utility of specific biomarkers in predicting pediatric CAP severity requires further investigation.
Purpose of the Study:
- To evaluate the association of white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), and procalcitonin with severe outcomes in children with CAP.
- To determine the discriminatory ability of these biomarkers in predicting disease severity in pediatric CAP.
- To assess the predictive value of biomarkers for specific severe complications.
Main Methods:
- A prospective cohort study was conducted on 477 children aged 3 months to 18 years diagnosed with CAP in an emergency department.
- Disease severity was categorized as mild, mild-moderate, moderate-severe, and severe.
- Biomarker levels (WBC, ANC, CRP, procalcitonin) were measured and analyzed for their association with severity categories and specific outcomes.
Main Results:
- No significant differences in median WBC, ANC, CRP, or procalcitonin levels were observed across different CAP severity categories.
- Biomarkers showed limited ability to discriminate between severe and non-severe CAP (AUC 0.53-0.64).
- CRP was associated with moderate-severe disease (OR 1.12), and CRP and procalcitonin showed good discrimination for empyema and sepsis (AUCs ranging from 0.74 to 0.83).
Conclusions:
- Standard biomarkers (WBC, ANC, CRP, procalcitonin) are generally not effective in distinguishing non-severe from severe CAP in children.
- CRP and procalcitonin may offer some predictive value for the most severe CAP complications, such as empyema and sepsis.
- Further research is needed to refine the role of biomarkers in managing pediatric CAP.
Background:
Host biomarkers predict disease severity in adults with community-acquired pneumonia (CAP). We evaluated the association of the white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), and procalcitonin with the development of severe outcomes in children with CAP.
Methods:
We performed a prospective cohort study of children 3 months to 18 years of age with CAP in the emergency department. The primary outcome was disease severity: mild (discharged from the hospital), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (eg, hospitalized with receipt of intravenous fluids, supplemental oxygen, complicated pneumonia), and severe (eg, intensive care, vasoactive infusions, chest drainage, severe sepsis). Outcomes were examined within the cohort with suspected CAP and in a subset with radiographic CAP.
Results:
Of 477 children, there were no statistical differences in the median WBC count, ANC, CRP, or procalcitonin across severity categories. No biomarker had adequate discriminatory ability between severe and nonsevere disease (area under the curve [AUC]: 0.53-0.6 for suspected CAP and 0.59-0.64 for radiographic CAP). In analyses adjusted for age, antibiotic use, fever duration, and viral pathogen detection, CRP was associated with moderate-severe disease (odds ratio 1.12; 95% confidence interval, 1.0-1.25). CRP and procalcitonin revealed good discrimination of children with empyema requiring chest drainage (AUC: 0.83) and sepsis with vasoactive infusions (CRP AUC: 0.74; procalcitonin AUC: 0.78), although prevalence of these outcomes was low.
Conclusions:
WBC count, ANC, CRP, and procalcitonin are generally not useful to discriminate nonsevere from severe disease in children with CAP, although CRP and procalcitonin may have some utility in predicting the most severe outcomes.
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