Pneumonia Severity in Children: Utility of Procalcitonin in Risk Stratification
Laura F Sartori1,2, Yuwei Zhu3, Carlos G Grijalva3
1Vanderbilt University Medical Center, Nashville, Tennessee; sartoril@email.chop.edu.
Insights
Serum procalcitonin levels correlate with community-acquired pneumonia severity in children. Higher procalcitonin indicates more severe disease and longer hospital stays, aiding clinical evaluation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Biomarkers
Background:
- Serum procalcitonin is a known indicator of bacterial infections and a severity predictor in adult pneumonia.
- Its role in assessing disease severity in pediatric community-acquired pneumonia (CAP) requires further investigation.
Purpose of the Study:
- To investigate the association between serum procalcitonin levels and the severity of community-acquired pneumonia in children.
- To determine if procalcitonin can predict clinical outcomes such as intensive care admission and length of hospital stay.
Main Methods:
- A prospective study enrolled 488 children (2 months to <18 years) with CAP.
- Pneumonia severity was categorized using an ordinal scale (very severe, severe, moderate, mild), and serum procalcitonin was measured at presentation.
- Ordinal logistic regression analyzed the association between procalcitonin levels and severity outcomes, including hospital length of stay (LOS).
Main Results:
- Higher serum procalcitonin levels were significantly associated with increased pneumonia severity.
- Median procalcitonin was highest in the very severe pneumonia group (5.06 ng/mL) and lowest in the mild group (0.21 ng/mL).
- Procalcitonin demonstrated a statistically significant association with both increased disease severity (aORs: 1.03-1.25) and longer hospital LOS (aORs: 1.04-1.36).
Conclusions:
- Elevated serum procalcitonin levels in children with CAP correlate with greater disease severity.
- Procalcitonin shows potential as a valuable tool for clinicians in evaluating pneumonia severity and guiding patient management.
Objectives:
To determine if serum procalcitonin, an indicator of bacterial etiology in pneumonia in all ages and a predictor of severe pneumonia in adults, is associated with disease severity in children with community-acquired pneumonia.
Methods:
We prospectively enrolled children 2 months to <18 years with clinical and radiographic pneumonia at 2 children's hospitals (2014-2019). Procalcitonin samples were obtained at presentation. An ordinal outcome scale of pneumonia severity was defined: very severe (intubation, shock, or death), severe (intensive care admission without very severe features and/or high-flow nasal cannula), moderate (hospitalization without severe or very severe features), and mild (discharge). Hospital length of stay (LOS) was also examined. Ordinal logistic regression was used to model associations between procalcitonin and outcomes. We estimated adjusted odds ratios (aORs) for a variety of cut points of procalcitonin ranging from 0.25 to 3.5 ng/mL.
Results:
The study included 488 children with pneumonia; 30 (6%) were classified as very severe, 106 (22%) as severe, 327 (67%) as moderate, and 25 (5%) as mild. Median procalcitonin in the very severe group was 5.06 (interquartile range [IQR] 0.90-16.83), 0.38 (IQR 0.11-2.11) in the severe group, 0.29 (IQR 0.09-1.90) in the moderate group, and 0.21 (IQR 0.12-1.2) in the mild group. Increasing procalcitonin was associated with increasing severity (range of aORs: 1.03-1.25) and increased LOS (range of aORs: 1.04-1.36). All comparisons were statistically significant.
Conclusions:
Higher procalcitonin was associated with increased severity and LOS. Procalcitonin may be useful in helping clinicians evaluate pneumonia severity.
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