Abstract
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.
Highlights
Community-acquired pneumonia (CAP), with viruses and bacteria as its main causes, is one of the leading causes of morbidity and mortality in young children worldwide [1]
This study indicates that in children with CAP, soluble triggering receptor expressed on myeloid cells-1 (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
The problems that pediatricians have in differentiating bacterial from viral CAP and in assessing the severity of the disease are highlighted by the poor predictive value evidenced in this study for white blood cell (WBC) count, neutrophil percentage, and C-reactive protein (CRP) and PCT levels
Summary
Community-acquired pneumonia (CAP), with viruses and bacteria as its main causes, is one of the leading causes of morbidity and mortality in young children worldwide [1]. The differentiation of viral from bacterial CAP is necessary for the rational use of antibiotics and the consequent reduction in the emergence of bacterial resistance and drug-related adverse events [3]. Both these goals are difficult to achieve, in younger children in whom the collection of respiratory samples is difficult or impossible to obtain [4]. In most cases, the results from routine laboratory tests, such as white blood cell (WBC) count and C-reactive protein (CRP) serum level determination, tend to overlap, making the differentiation impossible [5] This challenge 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]
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