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La Procalcitonina como Marcador de Infecciones Bacterianas Graves (IBG) en Niños Menores de 3 Años con Fiebre
Author(s) -
Mahajan Prashant,
Grzybowski Mary,
Chen Xinguang,
Kannikeswaran Nirupama,
Stanley Rachel,
Singal Bonita,
Hoyle John,
Borgialli Dominic,
Duffy Elizabeth,
Kuppermann Nathan
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12316
Subject(s) - medicine , procalcitonin , bacteremia , white blood cell , emergency department , meningitis , biomarker , pneumonia , sepsis , prospective cohort study , confidence interval , urine , urinary system , gastroenterology , pediatrics , antibiotics , biochemistry , chemistry , psychiatry , microbiology and biotechnology , biology
Objectives There is no perfectly sensitive or specific test for identifying young, febrile infants and children with occult serious bacterial infections ( SBI s). Studies of procalcitonin ( PCT ), a 116‐amino‐acid precursor of the hormone calcitonin, have demonstrated its potential as an acute‐phase biomarker for SBI . The objective of this study was to compare performance of serum PCT with traditional screening tests for detecting SBI s in young febrile infants and children. Methods This was a prospective, multicenter study on a convenience sample from May 2004 to December 2005. The study was conducted in four emergency departments ( ED s): one pediatric ED and three ED s with pediatric units, all with academic faculty on staff. A total of 226 febrile children 36 months old or younger who presented to the four participating ED s and were evaluated for SBI by blood, urine, and/or cerebral spinal fluid ( CSF ) cultures were included. Results The test characteristics (with 95% confidence intervals [CIs]) of the white blood cell (WBC) counts including neutrophil and band counts were compared with PCT for identifying SBI. Thirty children had SBIs (13.3%, 95% CI = 8.85 to 17.70). Four (13.3%) had bacteremia (including one with meningitis), 18 (60.0%) had urinary tract infections (UTIs), and eight (26.6%) had pneumonia. Children with SBIs had higher WBC counts (18.6 × 10 9 ± 8.6 × 10 9 cells/L vs. 11.5 × 10 9 ± 5.3 × 10 9 cells/L, p < 0.001), higher absolute neutrophil counts (ANCs; 10.6 × 10 9 ± 6.7 × 10 9 cells/L vs. 5.6 × 10 9 ± 3.8 × 10 9 cells/L, p = 0.009), higher absolute band counts (0.90 × 10 9 ± 1.1 × 10 9 cells/L vs. 0.35 × 10 9 ± 0.6 × 10 9 cells/L, p = 0.009), and higher PCT levels (2.9 ± 5.6 ng/ mL vs. 0.4 ± 0.8 ng/ mL , p = 0.021) than those without SBIs. In a multivariable logistic regression analysis, the absolute band count and PCT were the two screening tests independently associated with SBI, although the area under the receiver operating characteristic (ROC) curve for PCT was the largest (0.80, 95% CI = 0.71 to 0.89). Conclusions Procalcitonin is a more accurate biomarker than traditional screening tests for identifying young febrile infants and children with serious SBI s. Further study on a larger cohort of young febrile children is required to definitively determine the benefit of PCT over traditional laboratory screening tests for SBI s.