Usefulness of Procalcitonin in the Diagnosis of Bacterial Infection in Immunocompetent Children
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Published on: September 28, 2016
Hae Na Park1, Su Yeong Kim1, Na Mi Lee1
1Department of Pediatrics, Chung-Ang University Hospital, Seoul 06973, Korea.
Insights
This study found that procalcitonin (PCT) and other inflammatory biomarkers were not effective in distinguishing bacterial infections (BIs) from non-bacterial infections (NBIs) in children. Further research is needed to find more accurate diagnostic markers for BIs, particularly invasive ones.
Area of Science:
- Pediatric infectious diseases
- Clinical immunology
- Biomarker research
Background:
- Accurate differentiation between bacterial infections (BIs) and non-bacterial infections (NBIs) is crucial for timely antibiotic administration.
- Inflammatory biomarkers are essential for identifying BIs, but their diagnostic accuracy varies.
- Procalcitonin (PCT) is a potential biomarker for bacterial infections, particularly in pediatric populations.
Purpose of the Study:
- To evaluate the diagnostic utility of procalcitonin (PCT) in differentiating bacterial infections (BIs) from non-bacterial infections (NBIs) in immunocompetent children.
- To compare the efficacy of PCT with other inflammatory markers such as C-reactive protein (CRP), white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR).
- To assess the ability of these biomarkers to differentiate between various subtypes of bacterial infections, including invasive bacterial infections (IBIs).
Main Methods:
- Retrospective review of medical records of 474 immunocompetent children (<18 years) who underwent PCT measurements between July 2012 and June 2019.
- Patients were categorized into BI (n=205) and NBI (n=269) groups, with further subcategorization of BI into IBI, mucosal BI, toxigenic BI, and localized BI, and NBI into viral infection and inflammatory disease.
- Statistical analysis was performed to compare PCT, CRP, WBC, and ESR levels between groups, and receiver operating characteristic (ROC) curves were used to determine diagnostic accuracy (Area Under Curve - AUC).
Main Results:
- PCT and ESR showed significant differences between the overall BI and NBI groups (p=0.008 and p<0.001, respectively).
- WBC, ESR, and PCT were significantly different between the invasive BI (IBI) group and other groups (p=0.007, p<0.001, and p=0.005, respectively).
- Despite statistical significance, none of the evaluated biomarkers demonstrated sufficient accuracy in differentiating BI from NBI, and their performance was poor in distinguishing IBI from other conditions (AUC for WBC=0.615, PCT=0.640).
Conclusions:
- Current inflammatory biomarkers, including PCT, WBC, and ESR, are not sufficiently accurate for differentiating bacterial infections from non-bacterial infections in immunocompetent children.
- The ability of these biomarkers to distinguish invasive bacterial infections from other conditions is limited.
- Further research is imperative to identify novel and more precise biomarkers for the accurate diagnosis of bacterial infections, especially invasive types.
Abstract:
Bacterial infections (BIs) need to be differentiated from non-BIs (NBIs) to enable prompt administration of antibiotics. Therefore, inflammatory biomarkers are needed as they can accurately identify BIs. This study evaluated the usefulness of procalcitonin (PCT) in the diagnosis of BI in immunocompetent children. We retrospectively reviewed the medical records of patients <18 years who underwent PCT measurements between July 2012 and June 2019. In total, 474 patients were enrolled and divided into the BI (n = 205) and NBI groups (n = 269). The BI group was subcategorized into the invasive BI (IBI; n = 94), mucosal BI (MBI; n = 31), toxigenic BI (TBI; n = 23), and localized BI (LBI; n = 57) subgroups. The NBI group was further subcategorized into the viral infection (VI; n = 118) and inflammatory disease groups (ID; n = 151). PCT was compared with the levels of C-reactive protein (CRP), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). Between the BI and NBI groups, PCT (4.2 ± 16.9 vs. 1.1 ± 2.5 ng/mL; p = 0.008) and ESR (39.1 ± 32.4 vs. 54.8 ± 28.2 mm/h; p < 0.001) were significantly different. Between the IBI and other groups, WBC (14,797 ± 7148 vs. 12,622 ± 5770 × 106/L; p = 0.007), ESR (35.3 ± 30.3 vs. 51.5 ± 30.3 mm/h; p < 0.001), and PCT (8.1 ± 23.8 vs. 1.0 ± 3.4 ng/mL; p = 0.005) were significantly different. However, none of the biomarkers were useful in differentiating BI from NBI. While WBC (area under curve (AUC) = 0.615, p = 0.003) and PCT (AUC = 0.640, p < 0.001) were useful, they fared poorly in differentiating IBI from other groups. Thus, additional studies are needed to identify more accurate biomarkers capable of differentiating BIs, especially IBIs.
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