Utility of serum procalcitonin and C-reactive protein in severity assessment of community-acquired pneumonia in children

Agnello, Luisa; Bellia, Chiara; Gangi, Maria Di; Sasso, Bruna Lo; Calvaruso, Luca; Bivona, Giulia; Scazzone, Concetta; Dones, Piera; Ciaccio, Marcello

doi:10.1016/j.clinbiochem.2015.09.008

Cited by 53 publications

(53 citation statements)

References 34 publications

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“…Lee et al have reported an increase in both PCT and CRP in lobar CAP with respect to bronchopneumonia but have found that PCT has better sensitivity and specificity in detecting CAP with a radiological finding suggesting increased severity [50]. However, in a very recent publication, the superiority of PCT over CRP has been found to no longer be evident [51]. …”

Section: Evaluation Of the Severity Of Pediatric Capmentioning

confidence: 99%

Biomarkers in Pediatric Community-Acquired Pneumonia

Principi

Esposito

2017

IJMS

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Community-acquired pneumonia (CAP) is an infectious disease caused by bacteria, viruses, or a combination of these infectious agents. The severity of the clinical manifestations of CAP varies significantly. Consequently, both the differentiation of viral from bacterial CAP cases and the accurate assessment and prediction of disease severity are critical for effectively managing individuals with CAP. To solve questionable cases, several biomarkers indicating the etiology and severity of CAP have been studied. Unfortunately, only a few studies have examined the roles of these biomarkers in pediatric practice. The main aim of this paper is to detail current knowledge regarding the use of biomarkers to diagnose and treat CAP in children, analyzing the most recently published relevant studies. Despite several attempts, the etiologic diagnosis of pediatric CAP and the estimation of the potential outcome remain unsolved problems in most cases. Among traditional biomarkers, procalcitonin (PCT) appears to be the most effective for both selecting bacterial cases and evaluating the severity. However, a precise cut-off separating bacterial from viral and mild from severe cases has not been defined. The three-host protein assay based on C-reactive protein (CRP), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), plasma interferon-γ protein-10 (IP-10), and micro-array-based whole genome expression arrays might offer more advantages in comparison with former biomarkers. However, further studies are needed before the routine use of those presently in development can be recommended.

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Section: Evaluation Of the Severity Of Pediatric Capmentioning

confidence: 99%

Biomarkers in Pediatric Community-Acquired Pneumonia

Principi

Esposito

2017

IJMS

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“…Lee et al [26] found that PCT has a higher sensitivity and specificity than CRP in the differential diagnosis of lobar and bronchial pneumonia. Agnello et al [27] reported recently that CRP is better than PCT, neutrophil count, and WBC for the assessment of CAP severity. Our study did not find the advantages of traditional inflammation markers for the differential diagnosis of CAP severity, which may be attributed to the reduction of bacterial infections in CAP and the complexity of pathogens.…”

Section: Inflammation Markers and Assessment Of Cap Severity In Childrenmentioning

confidence: 99%

Valuable hematological indicators for the diagnosis and severity assessment of Chinese children with community-acquired pneumonia

Ning

Shao

et al. 2016

Medicine

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Chest X-ray is a “golden standard” for the diagnosis and severity assessment of community-acquired pneumonia (CAP). However, it cannot be used as routine examination of CAP in children. The present study aims to investigate the roles of prealbumin (PA) in CAP in children and further determine the usefulness of PA in diagnosis and severity assessment of CAP in children.This was a retrospective analysis of 174 cases of hospitalized children with CAP. The following indicators were recorded: vital sign, inflammatory indexes, PA, and respiratory pathogens immunoglobulin M antibody test results. A total of 33 healthy children were selected as the control group. The results of laboratory tests between CAP and control groups were compared. CAP group was further divided into mild CAP and severe CAP groups, and vital signs and laboratory examination results of 2 groups were compared.The total positive rate of Mycoplasma pneumoniae in this study was 27.4%, and there was no significant difference in different seasons (P = 0.356). Compared with controls, there was no significant difference between procalcitonin and C-reactive protein in CAP group (P = 0.355, 0.061). The white blood cell count, percentage of neutrophils, neutrophil count, and erythrocyte sedimentation rate in the CAP group were significantly higher than those in control group, and PA was significantly lower than that in the control group (all P < 0.05). In the traditional cutoff value (<170 mg/L), the sensitivity of PA for the diagnosis of CAP was 0.847, which was significant higher than traditional inflammatory indicators. Moreover, it was found that PA was an independent protective factor for CAP in children based on multivariate analysis (odds ratio: 0.974; 95% confidence interval: 0.956–0.993; P = 0.008). PA level in severe CAP group was significantly lower than in mild CAP group (P = 0.001). With a cutoff value of 125 mg/L, the sensitivity and specificity of PA for the severity assessment of CAP were 0.703 and 0.714, respectively.Combined with traditional inflammatory markers, PA may improve the diagnostic efficacy of CAP in children. PA can be used as a reference marker to complement the chest X-rays for severity assessment of children CAP.

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“…This challenge also exists when using procalcitonin (PCT) to define the etiology and severity of CAP. PCT was the latest biomarker to enter into routine clinical practice [6]. …”

Section: Introductionmentioning

confidence: 99%

Sensitivity and Specificity of Soluble Triggering Receptor Expressed on Myeloid Cells-1, Midregional Proatrial Natriuretic Peptide and Midregional Proadrenomedullin for Distinguishing Etiology and to Assess Severity in Community-Acquired Pneumonia

et al. 2016

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Study DesignThis study aimed to evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), midregional proatrial natriuretic peptide (MR-proANP) and midregional proadrenomedullin (MR-proADM) to distinguish bacterial from viral community-acquired pneumonia (CAP) and to identify severe cases in children hospitalized for radiologically confirmed CAP. Index test results were compared with those derived from routine diagnostic tests, i.e., white blood cell (WBC) counts, neutrophil percentages, and serum C-reactive protein (CRP) and procalcitonin (PCT) levels.MethodsThis prospective, multicenter study was carried out in the most important children’s hospitals (n = 11) in Italy and 433 otherwise healthy children hospitalized for radiologically confirmed CAP were enrolled. Among cases for whom etiology could be determined, CAP was ascribed to bacteria in 235 (54.3%) children and to one or more viruses in 111 (25.6%) children. A total of 312 (72.2%) children had severe disease.ResultsCRP and PCT had the best performances for both bacterial and viral CAP identification. The cut-off values with the highest combined sensitivity and specificity for the identification of bacterial and viral infections using CRP were ≥7.98 mg/L and ≤7.5 mg/L, respectively. When PCT was considered, the cut-off values with the highest combined sensitivity and specificity were ≥0.188 ng/mL for bacterial CAP and ≤0.07 ng/mL for viral CAP. For the identification of severe cases, the best results were obtained with evaluations of PCT and MR-proANP. However, in both cases, the biomarker cut-off with the highest combined sensitivity and specificity (≥0.093 ng/mL for PCT and ≥33.8 pmol/L for proANP) had a relatively good sensitivity (higher than 70%) but a limited specificity (of approximately 55%).ConclusionsThis study indicates that in children with CAP, sTREM-1, MR-proANP, and MR-proADM blood levels have poor abilities to differentiate bacterial from viral diseases or to identify severe cases, highlighting that PCT maintains the main role at this regard.

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Utility of serum procalcitonin and C-reactive protein in severity assessment of community-acquired pneumonia in children

Cited by 53 publications

References 34 publications

Biomarkers in Pediatric Community-Acquired Pneumonia

Biomarkers in Pediatric Community-Acquired Pneumonia

Valuable hematological indicators for the diagnosis and severity assessment of Chinese children with community-acquired pneumonia

Sensitivity and Specificity of Soluble Triggering Receptor Expressed on Myeloid Cells-1, Midregional Proatrial Natriuretic Peptide and Midregional Proadrenomedullin for Distinguishing Etiology and to Assess Severity in Community-Acquired Pneumonia

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