Procalcitonin, C-reactive protein, neutrophil gelatinase-associated lipocalin, resistin and the APTT waveform for the early diagnosis of serious bacterial infection and prediction of outcome in critically ill children

Abstract

Objective Bacterial Infections remains a leading cause of death in the Paediatric Intensive Care Unit (PICU). In this era of rising antimicrobial resistance, new tools are needed to guide antimicrobial use. The aim of this study was to investigate the accuracy of procalcitonin (PCT), neutrophil gelatinase-associated lipocalin (NGAL), resistin, activated partial thromboplastin time (aPTT) waveform and C-reactive protein (CRP) for the diagnosis of serious bacterial infection (SBI) in children on admission to PICU and their use as prognostic indicators. Setting A regional PICU in the United Kingdom. Patients Consecutive PICU admissions between October 2010 and June 2012. Measurements Blood samples were collected daily for biomarker measurement. The primary outcome measure was performance of study biomarkers for diagnosis of SBI on admission to PICU based on clinical, radiological and microbiological criteria. Secondary outcomes included durations of PICU stay and invasive ventilation and 28-day mortality. Patients were followed up to day 28 post-admission. Main results A total of 657 patients were included in the study. 92 patients (14%) fulfilled criteria for SBI. 28-day mortality was 2.6% (17/657), but 8.7% (8/92) for patients with SBI. The combination of PCT, resistin, plasma NGAL and CRP resulted in the greatest net reclassification improvement compared to CRP alone (0.69, p<0.005) with 10.5% reduction in correct classification of patients with SBI (p 0.52) but a 78% improvement in correct classification of patients without events (p <0.005). A statistical model of prolonged duration of PICU stay found log-transformed maximum values of biomarkers performed better than first recorded biomarkers. The final model included maximum values of CRP, plasma NGAL, lymphocyte and platelet count (AUC 79%, 95% CI 73.7% to 84.2%). Longitudinal profiles of biomarkers showed PCT levels to decrease most rapidly following admission SBI. Conclusion Combinations of biomarkers, including PCT, may improve accurate and timely identification of SBI on admission to PICU.

Comparación de los niveles de procalcitonina por microorganismo en niños con sepsis

“…El conocimiento actual del rol de la PCT en niños inmunocomprometidos es escaso. [29][30][31][32][33][34] previos en niños con cáncer que mostraron que la PCT es un marcador efectivo para sepsis durante un episodio de fiebre y neutropenia; sin embargo, ninguno de ellos evaluó el rol de la PCT para predecir la positividad de un hemocultivo. 30,34 Nuestro estudio reporta una sensibilidad de 87.5% para predecir la positividad de un hemocultivo en infecciones por BGN, lo que pudiera apoyar el uso de PCT como una herramienta útil en la práctica clínica.…”

“…Niveles de procalcitonina por microorganismo en niños Rev Latin Infect Pediatr. 2021; 34 (1):[27][28][29][30][31][32][33]…”

Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection (BATCH): protocol for a randomised controlled trial

“…Clinicians can overrule the algorithm if they feel it is appropriate to do so. The algorithm values are based on our now published work which is the largest study to prospectively assess the performance of multiple biomarkers of SBI in a heterogeneous cohort of critically ill children and uniquely profiles longitudinal biomarker changes within the cohort 9…”

“…We recently published a large study prospectively assessing the performance of multiple biomarkers of SBI in a heterogeneous cohort of critically ill children and uniquely profiled longitudinal biomarker changes. Longitudinal profiles for PCT showed the greatest percentage drop in values over the first 7 days of therapy in children with SBI, suggesting that PCT might be useful in guiding duration of antimicrobial therapy in children 9…”

“…Longitudinal profiles for PCT showed the greatest percentage drop in values over the first 7 days of therapy in children with SBI, suggesting that PCT might be useful in guiding duration of antimicrobial therapy in children. 9 …”