The clinical value of procalcitonin cut-off levels for pediatric patients in the hospital setting.

Abstract

Utilization of procalcitonin (PCT) is challenging for hospital pediatricians because of uncertainty in clinical interpretation. We used a PCT decision cut-off value (<0.15 ng/mL) to identify if PCT can differentiate bacterial infections from viral and other conditions in pediatric patients who presented for hospital-based care. This retrospective study included PCT tested patients who presented to our children's hospital from 2017 to 2020. We analyzed relevant demographic, laboratory, treatment, and clinical data, including discharge diagnoses consolidated into bacterial infections, viral syndromes, and other conditions by the highest PCT defined as ≤0.15 ng/mL (Group A) or >0.15 ng/mL (Group B). We used regression models to identify factors associated with PCT above decision limits and the role of PCT levels in the duration of antibiotic therapy. Of 238 patients, 32.8% constituted Group A. Bacterial infections represent 25.6% of diagnoses for patients in Group A and 55% for Group B (P<0.001), however, the distribution of bacterial infection types, including bacteremia, was comparable. Number of PCT tests performed and C-reactive protein (CRP) ≥5 mg/L, but no other factors were significantly associated with PCT >0.15 ng/mL. PCT levels did not predict the length of antibiotic therapy, which depended on duration of hospitalization and increased CRP. PCT as a single measurement above or below a decision cut-off value of 0.15 ng/mL does not specify bacterial infections or predict the duration of antibiotic therapy in hospitalized pediatric patients.