The Diagnostic and Prognostic Accuracy of Five Markers of Serious Bacterial Infection in Malawian Children with Signs of Severe Infection

Abstract

BackgroundEarly recognition and prompt and appropriate antibiotic treatment can significantly reduce mortality from serious bacterial infections (SBI). The aim of this study was to evaluate the utility of five markers of infection: C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), CD163 and high mobility group box-1 (HMGB1), as markers of SBI in severely ill Malawian children.Methodology and Principal FindingsChildren presenting with a signs of meningitis (n = 282) or pneumonia (n = 95), were prospectively recruited. Plasma samples were taken on admission for CRP, PCT, sTREM-1 CD163 and HMGB1 and the performance characteristics of each test to diagnose SBI and to predict mortality were determined. Of 377 children, 279 (74%) had SBI and 83 (22%) died. Plasma CRP, PCT, CD163 and HMGB1 and were higher in HIV-infected children than in HIV-uninfected children (p<0.01). In HIV-infected children, CRP and PCT were higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and PCT and CD163 were higher in non-survivors (p = 0.001, p = 0.05 respectively). In HIV-uninfected children, CRP and PCT were also higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and CD163 was higher in non-survivors (p = 0.05). The best predictors of SBI were CRP and PCT, and areas under the curve (AUCs) were 0.81 (95% CI 0.73–0.89) and 0.86 (95% CI 0.79–0.92) respectively. The best marker for predicting death was PCT, AUC 0.61 (95% CI 0.50–0.71).ConclusionsAdmission PCT and CRP are useful markers of invasive bacterial infection in severely ill African children. The study of these markers using rapid tests in a less selected cohort would be important in this setting.

The Association of Positive Chest Radiograph and Laboratory Parameters with Community Acquired Pneumonia in Children

“…However, our results contradicted the results of the studies which were done by Patenaude et al, [19] 1995 (86%) and Bharti B et al, [20] in 2008 (83.1%). The sensitivity of the C-reactive protein, which was observed in our study was 90.9%, which matched with those of the studies which were done by Heiskanen-Kosma T et al, [21] in 2000 (94.3%), by Requejo HI et al, [22] in 2003 (98%) and by Enitan D and Carrol et al, [23] in 2009 (97.2%). Our results differed from those of the studies which were done by Massimiliano Don et al, [24] in 2009 (74%) and Virkki R et al, [25] in 2002 (73.5%).…”

The uselessness of procalcitonin in the diagnosis of focal bacterial central nervous system infection

“…As in previous study [1,4], serum procalcitonin level was markedly elevated in the patients with meningitis caused by hematogenous spread of bacteria. Of these patients, the patients with sequelae or complication especially had high serum procalcitonin level, indicating that it is a useful marker for the prediction of severity and prognosis.…”

“…Procalcitonin is a useful marker not only in the diagnosis of severe bacterial infection such as sepsis and bacterial meningitis but also in the prediction of the prognosis of these diseases [1]. On the other hand, serum procalcitonin level is hard to be elevated in focal infection [2,3].…”

“…Early diagnosis and treatment for central nervous system (CNS) infection represented by bacterial meningitis and brain abscess are important because the mortality rate and the incidence of neurological sequelae are high in these diseases. The utilities of serum procalcitonin in the diagnosis and the prediction of prognosis of bacterial meningitis have been well known [1,4], whereas those of focal CNS infection such as brain abscess and subdural empyema are uncertain. To investigate the utility of procalcitonin in the diagnosis of focal bacterial CNS infection, we compared serum procalcitonin levels between the patients with meningitis due to hematogenous dissemination of bacteria and the patients with focal bacterial CNS infection.…”

Caracterización de la expresión de nCD64 en neutrófilos y de los niveles de s-TREM-1 y HMGB-1 en pacientes con sospecha de infección admitidos en el departamento de emergencias

“…Higher levels of HMGB-1 have been shown patients with fatal outcome (36,38), as well as in patients with infection as compared to healthy controls (38,40). Other studies, however, have shown no statistically significant difference in serum levels of HMGB-1 between infected and the non-infected patients (40,41), using the same commercial kit utilized in this study. In the absence of general consensus in the literature, the role of HMGB-1 remains debatable, as this molecule parallels other severity markers and may not provide further specific information regarding outcome (5).…”