Procalcitonin and C-reactive protein in WHO defined severe and very severe community acquired pneumonia: A hospital based cross-sectional study

Yadav, Krishna Kumar; Awasthi, Sanjay; Takia, Lalit; Agarwal, Jyotsna; Agarwal, Gaurav

doi:10.1016/j.cegh.2015.11.005

Cited by 11 publications

(10 citation statements)

References 23 publications

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“…Increased levels of CRP and PCT were shown to be good predictors of mortality. This is in line with Yadav et al, namely that CRP and PCT have a linear positive correlation with the severity of pneumonia [30]. Wu et al concluded that increased levels of CRP are closely associated with bacterial infection and severe pneumonia [31].…”

Section: Discussionsupporting

confidence: 84%

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Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia

et al. 2021

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Background: Clinical manifestations for pneumonia vary from mild to severe. The PIRO model (predisposition, insult, response, organ dysfunction) was used as scoring system to determine severity of sepsis and pneumonia in adult patients. The PIRO model was modified for sorting the severity of pneumonia in children and predicting its risk of mortality.Methods: An ambispective cohort study of pneumonia patients aged 1 month ≤18 years admitted over the period from May to September 2020. Data were collected from history, physical examination, laboratory examination, and chest radiography. Based on bivariate analysis (p<0.05 and relative risk (RR) with 95% confidence interval), variables of each PIRO component that were significant for mortality were assigned a value of 1. The cut-off score for predictor of mortality was calculated using the receiver operating characteristics (ROC) curve. Stratify the score into three degrees of risk based on interquartile range. Score ≤Q1 is categorized as low risk; Q1-Q3 is categorized as moderate risk; and score >Q3 is categorized as high risk.Results: Out of the 80 subjects subjects enrolled, 6 months-5 years was the largest age group (56.3%). The observed mortality was 15/80 (18.8%). The modified PIRO severity score was compiled from significant variable of predisposition (malnutrition), insult (chest radiograph), response (hypoxemia, hypotension, CRP >0.5 mg/dL, PCT >0.5 ng/dL) and organ dysfunction, with range of score 0-7. Score >3 as a cutoff point score for predictor of mortality with AUC 0.919 (95% CI 0.836–0.968), sensitivity of 80%, and specificity of 84.62%. Subjects with score >3 have RR of 10.544 compared to those with score ≤3. The stratification of score level was low (≤2), moderate (3-4), and high (5-7). The mortality levels were 0%, 46.7%, and 53.3%, respectively.Conclusions: Modified PIRO severity score can be used as a sorting tool and predictor of mortality risk in children with pneumonia. This score can also be used to select candidates for intensive care, especially in health facilities with limited intensive care capacity.

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Section: Discussionsupporting

confidence: 84%

“…Increased levels of CRP and PCT were shown to be good predictors of mortality. This is in line with Yadav et al ., namely that CRP and PCT have a linear positive correlation with the severity of pneumonia [ 30 ]. Wu et al .…”

Section: Discussionmentioning

confidence: 99%

Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia

et al. 2021

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“…Peripheral blood smear usually showed leucocytosis with neutrophilic predominance. Among the commonly studied biomarkers, levels of acute phase reactants, C-reactive protein (CRP) and procalcitonin (PCT) were found to be increased [Don et al 2005; Yadav et al 2015]. PCT was found to be a better predictor of severity of CAP in children than CRP [Yadav et al 2015].…”

Section: Methodsmentioning

confidence: 99%

“…Among the commonly studied biomarkers, levels of acute phase reactants, C-reactive protein (CRP) and procalcitonin (PCT) were found to be increased [Don et al 2005; Yadav et al 2015]. PCT was found to be a better predictor of severity of CAP in children than CRP [Yadav et al 2015]. X-ray of the chest is not routinely required for diagnosing CAP but needed when there is a doubt in the diagnosis, persisting symptoms, suspicion of complications like pleural effusion, pneumothorax, and so on [Harris et al 2011].…”

Section: Methodsmentioning

confidence: 99%

The current status of community-acquired pneumonia management and prevention in children under 5 years of age in India: a review

Yadav

Awasthi

2016

Therapeutic Advances in Infection

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India has the highest number of global deaths of children under 5 years of age. In the year 2015, it was reported that there were 5.9 million deaths of children under 5 years of age globally, of which 1.2 million (20%) occurred in India alone. Currently, India has an under 5 mortality rate of 48 per 1000 live births. Community-acquired pneumonia contributes to about one sixth of this mortality. Fast breathing is the key symptom of community-acquired pneumonia. The World Health Organization recently categorized community-acquired pneumonia in children under 5 years of age into two, pneumonia, and severe pneumonia. Fast breathing with or without chest in-drawing is categorized as pneumonia and fast breathing with any of danger signs as severe pneumonia. Because effective vaccines against two of the common organisms causing community-acquired pneumonia, namely Streptococcus pneumoniae and Haemophilus influenzae type b, are available, there should be urgent and phased introduction into the Indian Universal Immunization Programme. Several preventable risk factors of community-acquired pneumonia such as lack of exclusive breast feeding for first 6 months of life, inappropriate complimentary feeding, iron deficiency anemia, malnutrition, and indoor air pollution should be adequately addressed. The community should be aware about the signs and symptoms of community-acquired pneumonia and its danger signs so that delay in qualified care seeking can be avoided. To achieve the sustainable development goal of ⩽25 under five deaths per 1000 live births by 2030, a multipronged approach is the need of the hour.

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“…A multicenter, prospective study found increasing levels of procalcitonin were associated with ICU admission and empyema requiring drainage, and values <0.25 ng/mL were associated with decreased risk of ICU admission [79]. An Indian study found that elevation in admission procalcitonin in radiographically confirmed and WHO-defined severe or very severe pneumonia was associated with increased LOS and pneumonia complications [80]. In a prospective study of children diagnosed with CAP in the ED, Don et al [74] found that elevated procalcitonin was associated with hospitalization, whereas a cross-sectional study of hospitalized children found no association with markers for severity including tachycardia, hypoxemia, and dyspnea [78].…”

Section: Inflammatory Markersmentioning

confidence: 99%

Factors Associated With Pneumonia Severity in Children: A Systematic Review

Dean

Florin

2018

Journal of the Pediatric Infectious Diseases Society

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Community-acquired pneumonia in children is associated with significant morbidity and mortality; however, data are limited in predicting which children will have negative outcomes, including clinical deterioration, severe disease, or development of complications. The Pediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) pediatric pneumonia guideline includes criteria that were modified from adult criteria and define pneumonia severity to assist with resource allocation and site-of-care decision-making. However, the PIDS/IDSA criteria have not been formally developed or validated in children. Definitions for mild, moderate, and severe pneumonia also vary across the literature, further complicating the development of standardized severity criteria. This systematic review summarizes (1) the current state of the evidence for defining and predicting pneumonia severity in children as well as (2) emerging evidence focused on risk stratification of children with pneumonia.

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Procalcitonin and C-reactive protein in WHO defined severe and very severe community acquired pneumonia: A hospital based cross-sectional study

Cited by 11 publications

References 23 publications

Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia

Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia

The current status of community-acquired pneumonia management and prevention in children under 5 years of age in India: a review

Factors Associated With Pneumonia Severity in Children: A Systematic Review

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