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Published on: February 17, 2023
Systematic Review and Meta-Analysis of Diagnostic Biomarkers for Pediatric Pneumonia
Lourdes Cynthia Gunaratnam1, Joan L Robinson1, Michael T Hawkes1,2,3,4,5
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Insights
Accurate identification of bacterial pneumonia in children is crucial. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) show promise but require further research for optimal sensitivity in diagnosing pediatric pneumonia.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Biomarkers
- Respiratory Illnesses
Background:
- Pneumonia is a leading cause of child mortality globally, particularly in resource-limited areas.
- Accurate etiological diagnosis is vital for appropriate antibiotic use and resistance management.
- Host biomarkers may enhance the diagnosis of bacterial pneumonia in children with respiratory distress.
Purpose of the Study:
- To assess the diagnostic accuracy of various biomarkers for identifying bacterial pneumonia in children presenting with respiratory distress.
Main Methods:
- A comprehensive literature search was conducted across multiple databases up to May 2020.
- Included studies compared diagnostic biomarkers in children with bacterial pneumonia versus non-bacterial respiratory distress.
- Meta-analysis was performed on studies with sufficient data for biomarkers such as CRP, PCT, WBC, and ESR.
Main Results:
- 31 studies evaluated 23 biomarkers; CRP and PCT demonstrated the best differentiation between bacterial and viral pneumonia.
- CRP and PCT showed moderate diagnostic performance (AUROC ~0.70), with sensitivities around 70% and specificities around 64%.
- White blood cell (WBC) count and erythrocyte sedimentation rate (ESR) performed less effectively; novel biomarkers show potential, especially in combination.
Conclusions:
- C-reactive protein (CRP) and procalcitonin (PCT) are more effective than WBC and ESR for diagnosing pediatric bacterial pneumonia but have suboptimal sensitivity.
- Further investigation into novel biomarkers, particularly in combined applications, is warranted to improve diagnostic accuracy for childhood pneumonia.
Background:
Pneumonia causes significant morbidity and mortality in children worldwide, especially in resource-poor settings. Accurate identification of bacterial etiology leads to timely antibiotic initiation, minimizing overuse, and development of resistance. Host biomarkers may improve diagnostic sensitivity and specificity. We assessed the ability of biomarkers to correctly identify bacterial pneumonia in children who present with respiratory distress.
Methods:
A librarian-directed search was conducted of MEDLINE, EMBASE, CENTRAL, Global Health, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to May 2020 with no language restriction. Included studies compared a diagnostic biomarker in children with bacterial pneumonia to those with nonbacterial respiratory distress.
Results:
There were 31 observational studies of 23 different biomarkers. C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were the biomarkers with sufficient data for meta-analysis. Meta-analysis revealed that CRP and PCT best differentiated bacterial from viral pneumonia with CRP summary AUROC (area under the receiver operating characteristic curve) 0.71 (0.69-0.73), Youden index 53 mg/L, sensitivity 0.70 (0.68-0.78), and specificity 0.64 (0.58-0.68) and PCT summary AUROC 0.70 (0.67-0.74), Youden index 0.59 ng/mL, sensitivity 0.69 (0.65-0.77), and specificity 0.64 (0.60-0.68). WBC and ESR did not perform as well. Nineteen other inflammatory and immunologic biomarkers were identified including CRP/mean platelet value, neutrophil/leukocyte ratio, interleukin 6, and interferon-alpha, with sensitivities from 60% to 85% and specificities from 76% to 83%.
Conclusion:
CRP and PCT performed better than WBC and ESR but had suboptimal sensitivity. Some less well-studied novel biomarkers appear to have promise particularly in combination.
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