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Serum Procalcitonin as a Diagnostic and Prognostic Marker in Children With Severe Bacterial Infection: A Prospective
Upendra Prasad Sahu1, Manisha Singh1, Omar Hasan1
1Department of Pediatrics, Rajendra Institute of Medical Sciences, Ranchi, IND.
Insights
Serum procalcitonin (PCT) is a better predictor of mortality and severity in children with severe bacterial infections (SBI) than C-reactive protein (CRP). Day 1 PCT levels accurately identify children needing intensive care, improving resource allocation.
Area of Science:
- Pediatric Infectious Diseases
- Biomarker Research
- Clinical Diagnostics
Background:
- Early recognition of severe bacterial infections (SBI) in children is crucial for effective treatment.
- Traditional markers like C-reactive protein (CRP) have limitations in accuracy for diagnosing SBI.
- Serum procalcitonin (PCT) shows potential as a rapid and reliable marker for bacterial infections.
Purpose of the Study:
- To compare the diagnostic and prognostic performance of day 1 PCT versus CRP in children with suspected SBI.
- To evaluate PCT's accuracy in predicting outcomes such as PICU admission, hospital length of stay, and mortality.
- To assess the utility of PCT in a tertiary care setting in eastern India.
Main Methods:
- Prospective observational study involving 212 children (1 month-18 years) admitted with suspected SBI.
- Serum PCT and CRP levels measured within six hours of admission.
- Diagnostic accuracy assessed using receiver-operating-characteristic (ROC) curves; sensitivity and specificity calculated.
Main Results:
- Day 1 PCT levels were significantly higher in non-survivors compared to survivors (3.96 vs. 1.22 ng/mL).
- PCT demonstrated superior accuracy in predicting mortality (AUC: 0.954) compared to CRP (AUC: 0.770).
- A PCT threshold of 2.0 ng/mL showed 87.5% sensitivity and 81.1% specificity for mortality prediction; longer hospital stays correlated with higher PCT quartiles.
Conclusions:
- Day 1 PCT is a more effective biomarker than CRP for early risk-stratification in pediatric bacterial infections.
- PCT aids in identifying children requiring intensive care and prolonged treatment, optimizing resource allocation.
- Implementing PCT in admission protocols can improve antibiotic stewardship, especially in resource-limited settings.
Background:
Early recognition of severe bacterial infection (SBI) in children is critical, yet traditional markers such as C‑reactive protein (CRP) lack adequate accuracy. Serum procalcitonin (PCT) rises rapidly after bacterial insult and may offer both diagnostic and prognostic value.
Objectives:
To compare the diagnostic and prognostic performance of day 1 PCT with CRP in children with suspected SBI at a tertiary center in eastern India.
Methods:
In this prospective observational study (July 2021 - June 2022), we enrolled 212 children (one month-18 years) admitted to the Department of Pediatrics, Rajendra Institute of Medical Sciences, Ranchi. Serum PCT and CRP were measured within six hours of admission. Outcomes included PICU admission, hospital length of stay (LOS), and in‑hospital mortality. Diagnostic accuracy was assessed with receiver‑operating‑characteristic (ROC) curves; sensitivity and specificity at the optimal PCT cut‑off were calculated with Wilson 95% confidence intervals (CI).
Results:
Median day 1 PCT was significantly higher in non‑survivors than survivors (3.96 ng mL⁻¹ vs. 1.22 ng mL⁻¹, p<0.001). For predicting mortality, PCT showed an area under the ROC curve (AUC) of 0.954 (95% CI: 0.90-0.99), markedly superior to CRP (AUC: 0.770, 95% CI: 0.62-0.89). A PCT threshold of 2.0 ng mL⁻¹ yielded 87.5% sensitivity (95% CI: 64.0-96.5) and 81.1% specificity (95% CI: 75.1-86.0) for mortality prediction. Mean LOS increased stepwise across PCT quartiles (Q1: 6.3 days → Q4: 8.8 days, p<0.001).
Conclusions:
Day 1 PCT outperforms CRP for early risk‑stratification in pediatric bacterial infection, accurately identifying children who require intensive care and prolonged therapy. Incorporating PCT into admission protocols could enhance antibiotic stewardship and optimize PICU resource allocation, particularly in resource‑limited settings.
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