Accuracy of procalcitonin in detecting severe bacterial infections among critically ill children

Abstract

Objectives: The aims of this study are to determine the accuracy of serum procalcitonin (PCT) in the early detection of severe bacterial infections among critically ill children and to establish the correlation between PCT changes and clinical outcomes. Design: This was a prospective, observational study at Queen Sirikit National Institute of Child Health, Bangkok, Thailand, between March 2014 and December 2014. Materials and Methods: Children aged between 1 month and 15 years with acute severe life-threatening conditions were included. Microbiologic specimens were sent for multiplex polymerase chain reaction and bacterial culture on day 1 of hospitalization. PCT was obtained on days 1, 2, 3, and 5. Measurement and Main Results: A total of 61 patients with a mean age of 21.2 months were enrolled. Microbiologic specimens were sent for multiplex polymerase chain reaction and bacterial culture on day 1 of hospitalization. PCT was obtained on days 1, 2, 3, and 5. The medians of PCT levels on days 1 and 2 from the bacterial infections group were significantly higher than those from the viral infections group and the mixed infections group. The sensitivity, specificity, and area under the PCT curve (cutoff value ≥1.1 ng/ml) employed to predict bacterial infections were 67.7%, 73.7%, and 0.72, respectively. The percentage changes of PCT levels on days 2–5 correlated with those of pediatric logistic organ dysfunction (PELOD) scores on days 1–5 but did not correlate significantly with the lengths of PICU stay. Conclusions: PCT is a moderately accurate option for the early detection of bacterial infections among children with acute severe life-threatening conditions since there is a correlation between the percentage changes of PCT levels and PELOD scores but no significant correlation between the percentage changes of PCT levels and the length of PICU stay.W