Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit

Objectives To determine whether peak blood procalcitonin (PCT) measured within 48 hours of pediatric intensive care unit (PICU) admission can differentiate severe bacterial infections from sterile inflammation and viral infection and identify potential subgroups of PICU patients for whom PCT may not...

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Bibliographic Details
Published in:The Journal of pediatrics 2016-12, Vol.179, p.74-81.e2
Main Authors: Lautz, Andrew J., MD, Dziorny, Adam C., MD, PhD, Denson, Adam R., CRNP, O'Connor, Kathleen A., CRNP, Chilutti, Marianne R., MS, Ross, Rachael K., MPH, Gerber, Jeffrey S., MD, PhD, Weiss, Scott L., MD, MSCE
Format: Article
Language:English
Subjects:
Adolescent
Bacterial Infections - blood
Bacterial Infections - diagnosis
biomarker
Calcitonin - blood
Child
Child, Preschool
Diagnosis, Differential
False Negative Reactions
False Positive Reactions
Humans
Infant
Intensive Care Units, Pediatric
Pediatrics
PICU
Retrospective Studies
sepsis
Severity of Illness Index
Virus Diseases - blood
Virus Diseases - diagnosis
Young Adult
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Summary:Objectives To determine whether peak blood procalcitonin (PCT) measured within 48 hours of pediatric intensive care unit (PICU) admission can differentiate severe bacterial infections from sterile inflammation and viral infection and identify potential subgroups of PICU patients for whom PCT may not have clinical utility. Study design This was a retrospective, observational study of 646 critically ill children who had PCT measured within 48 hours of admission to an urban, academic PICU. Patients were stratified into 6 categories by infection status. We compared test characteristics for peak PCT, C-reactive protein (CRP), white blood cell count (WBC), absolute neutrophil count (ANC), and % immature neutrophils. The area under the receiver operating characteristic curve was determined for each biomarker to discriminate bacterial infection. Results The area under the receiver operating characteristic curve was similar for PCT (0.73, 95% CI 0.69, 0.77) and CRP (0.75, 95% CI 0.71, 0.79; P  = .36), but both outperformed WBC, ANC, and % immature neutrophils ( P  
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2016.07.045