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Fever duration enhanced biomarker sensitivity in diagnosing radiographically confirmed community-acquired pneumonia

Ori Goldberg1,2,3, Einat Shmueli1,2, Yoel Levinsky1,2

  • 1Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.

Acta Paediatrica (Oslo, Norway : 1992)
|December 16, 2024
PubMed

Insights

Fever duration impacts the diagnostic accuracy of biomarkers for community-acquired pneumonia (CAP) in children. The neutrophil-to-lymphocyte ratio (NLR) demonstrated the most consistent reliability from day 2 onwards.

Area of Science:

  • Pediatric infectious diseases
  • Biomarker research
  • Diagnostic accuracy studies

Background:

  • Community-acquired pneumonia (CAP) diagnosis in children often relies on clinical symptoms and imaging.
  • Biomarkers are increasingly used to aid diagnosis, but their effectiveness can be influenced by factors like fever duration.
  • Understanding how fever duration affects biomarker performance is crucial for accurate and timely diagnosis.

Purpose of the Study:

  • To investigate the impact of fever duration on the diagnostic utility of various biomarkers for identifying X-ray positive CAP in pediatric patients.
  • To determine optimal biomarker thresholds and their reliability across different stages of fever.

Main Methods:

  • Retrospective cohort study of children (2-18 years) diagnosed with CAP.
  • Analysis of biomarker measurements (white blood cell count, absolute neutrophil count, neutrophil-to-lymphocyte ratio, C-reactive protein) and chest radiographs.
  • Receiver operating characteristic (ROC) curve analysis to assess diagnostic performance and identify optimal thresholds.

Main Results:

  • Biomarkers were generally unreliable on day 1 of fever.
  • White blood counts and absolute neutrophil counts showed discriminatory power by day 2.
  • Neutrophil-to-lymphocyte ratio (NLR) demonstrated significant discriminatory power from day 2 to 5, peaking on day 4.
  • C-reactive protein became discriminatory on day 4.

Conclusions:

  • Fever duration significantly influences the diagnostic accuracy of biomarkers for CAP in children.
  • The NLR emerged as the most consistently reliable biomarker for diagnosing X-ray positive CAP, particularly from day 2 onwards.
  • Incorporating fever duration into diagnostic strategies can optimize the use of biomarkers for CAP.
Abstract

Keywords:
C‐reactive proteinbiomarkerscommunity‐acquired pneumoniaemergency departmentneutrophil–lymphocyte ratio

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