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Procalcitonin as a Severity-Based Risk Stratification Marker in Pediatric Infectious Diarrhea: A Prospective Study
Min-Jung Jan1, Chun-Yu Chen2,3, Yu-Jun Chang4
1Department of Medical Education, Tungs' Taichung MetroHarbor Hospital, Taichung 435, Taiwan.
Insights
Procalcitonin (PCT) does not diagnose Salmonella in children with infectious diarrhea. However, elevated PCT levels in the emergency department (ED) strongly indicate disease severity, guiding hospitalization and treatment decisions.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Chemistry
- Emergency Medicine
Background:
- Procalcitonin (PCT) is increasingly used in emergency settings to evaluate febrile illnesses.
- The role of PCT in pediatric infectious diarrhea, especially as a severity marker, requires further clarification.
- Understanding PCT's utility can optimize emergency department (ED) assessments for pediatric gastrointestinal infections.
Purpose of the Study:
- To evaluate the correlation between procalcitonin (PCT) levels and clinical severity in children with infectious diarrhea presenting to the ED.
- To assess PCT's association with specific outcomes such as hospitalization, length of stay, and antibiotic use.
- To determine if PCT can serve as a marker for Salmonella enteritidis infection or disease severity.
Main Methods:
- A prospective study enrolled 105 children with infectious diarrhea in a tertiary pediatric ED.
- Serum PCT, C-reactive protein (CRP), clinical features, hydration status, and treatment decisions were analyzed.
- PCT cutoffs were evaluated for associations with Salmonella infection and severity measures (dehydration, hospitalization, length of stay, antibiotic use).
Main Results:
- PCT levels did not differ between Salmonella-positive and negative cases, showing poor diagnostic performance for Salmonella.
- Elevated PCT (≥ 0.25 ng/mL) was strongly associated with increased hospitalization rates (92.1% vs. 52.6%), longer hospital stays (4.41 vs. 3.00 days), and greater antibiotic use (66.7% vs. 23.7%).
- Higher PCT levels correlated with more dehydration, higher CRP, and overall increased treatment intensity.
Conclusions:
- Procalcitonin (PCT) is not a reliable diagnostic marker for Salmonella enteritidis in pediatric infectious diarrhea.
- PCT effectively reflects the host's inflammatory response and is a strong indicator of clinical severity in pediatric infectious diarrhea.
- Incorporating PCT thresholds into ED assessments can aid in early risk stratification, informing decisions on admission and treatment intensity.
Abstract:
Objectives: Procalcitonin (PCT) is used increasingly in emergency settings to guide evaluation of febrile illnesses, but its role in pediatric infectious diarrhea, particularly as a marker of severity, remains unclear. The study objective evaluates whether PCT correlates with clinical severity and outcomes in pediatric infectious diarrhea presenting to the emergency department (ED). Methods: This prospective study enrolled 105 children with infectious diarrhea presenting to a tertiary pediatric ED. Serum PCT, C-reactive protein, clinical features, hydration status, treatment decisions (including hospitalization and antibiotic use), and outcomes were analyzed. PCT cutoffs (<0.25, <0.5, and <1.0 ng/mL) were evaluated for their associations with Salmonella infection and severity measures, including dehydration, hospitalization, length of stay, and antibiotic use. Results: Thirty-five patients (33.3%) had Salmonella enteritidis. PCT levels did not differ significantly between Salmonella-positive and negative cases (median 0.49 vs. 0.46 ng/mL; p = 0.84), and PCT demonstrated poor diagnostic performance (AUC 0.49). In contrast, PCT was strongly associated with markers of severity. Compared with lower PCT levels, children with PCT ≥ 0.25 ng/mL were more frequently hospitalized (92.1% vs. 52.6%; p < 0.001) and had longer hospital stays (4.41 vs. 3.00 days; p < 0.001). Higher PCT levels were also associated with more dehydration, higher CRP (all p < 0.001), and greater antibiotic use (66.7% vs. 23.7%; p < 0.001). PCT thresholds of 0.25-0.5 ng/mL consistently identified children at increased risk for admission and higher treatment intensity. Conclusions: PCT should not be used as a diagnostic marker for Salmonella enteritidis. Instead, it reflects the host inflammatory response and is strongly associated with clinical severity in children with acute infectious diarrhea evaluated in the ED. The incorporation of PCT thresholds into ED assessment may support early severity-based risk stratification and inform decisions regarding admission and treatment intensity.
