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

Abstract

ObjectivesAlthough the importance of serum Procalcitonin (PCT) levels at diagnosis is well established in adult Community-Acquired Pneumonia (CAP), its use remains controversial in pediatric CAP. The aim of our study is to investigate the role of PCT and C-Reactive Protein (CRP) in the assessment of pediatric CAP severity defined by the extent of consolidation on chest X-rays and the presence of pleural effusion. In this particular setting, no clinical severity score is available at present and chest X-ray, although important for diagnosis confirmation, is not recommended as routine test. Design and methodsThe study involved 119 children admitted to the Department of Pediatric Infectious Disease for radiographically documented CAP aged 1year to 14years, without chronic diseases. Baseline PCT, CRP and routine laboratory tests were performed on admission. ResultsThe median PCT (μg/L) and CRP (mg/L) were 0.11 (0.05–0.58) and 21.3 (4.2–48.1), respectively. PCT showed a good correlation with CRP, neutrophils and WBC (r=0.538, P<0.001; r=0.377, P<0.001; r=0.285, P0.002, respectively). CRP, but not PCT, was associated with lobar consolidation (P=0.007) and pleural effusion (P=0.002). Logistic regression analysis revealed that only CRP was a predictor of lobar consolidation (OR: 1.078; 95% CI: 1.017–1.143; P=0.011) and pleural effusion (OR: 1.076; 95% CI: 1.005–1.153; P=0.036). ConclusionOur findings revealed that PCT is correlated to the main inflammatory markers in children with CAP. CRP, unlike PCT, is able to predict the extent of chest X-ray infiltration and ultimately the severity of the disease confirming its usefulness in the management of pneumonia.