Korean J Lab Med.  2010 Aug;30(4):406-413. 10.3343/kjlm.2010.30.4.406.

Clinical Significance of Serum Procalcitonin in Patients with Community-acquired Lobar Pneumonia

• Lee JY
• Hwang SJ
• Shim JW
• Jung HL
• Park MS
• Woo HY
• Shim JY

• KMID: 1781648
• DOI: http://doi.org/10.3343/kjlm.2010.30.4.406

Abstract

BACKGROUND
Community-acquired pneumonia (CAP) is a common respiratory disorder in children, which necessitates hospitalization. Bacterial pneumonia, especially lobar pneumonia and parapneumonic effusions, is associated with considerably severe clinical course and extensive alveolar infiltrates. Serum procalcitonin (PCT) level has been used to distinguish bacterial from viral infections, but its usefulness is disputed. The diagnostic accuracy and usefulness of PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count were determined by comparing their values in the patients with CAP with those in healthy controls.
METHODS
The serum PCT levels, as well as CRP level, ESR, and WBC counts, were measured in 76 hospitalized patients with CAP (lobar pneumonia, 16; bronchopneumonia, 60) and 18 healthy controls. Serum PCT level was measured using VIDAS(R) BRAHMS PCT (Biomerieux, France), and ROC curve analysis was performed to evaluate its diagnostic accuracy.
RESULTS
Serum PCT levels were higher in the patients with CAP than in healthy controls, especially in the patients with lobar pneumonia than in those with bronchopneumonia. Serum CRP level was also significantly elevated in the patients with CAP, especially in those with lobar pneumonia. The diagnostic accuracy of serum PCT level for the diagnosis of lobar pneumonia was better than those of serum CRP level and ESR. The serum PCT level was significantly correlated with the CRP level, ESR, and WBC count.
CONCLUSIONS
Serum PCT level was a better marker than CRP level or ESR for the diagnosis of lobar pneumonia in children with CAP.

Keyword

Procalcitonin; Child; C-reactive protein; Pneumonia; Erythrocyte sedimentation rate

MeSH Terms

Adolescent
Biological Markers/blood
Blood Sedimentation
Bronchopneumonia/complications
C-Reactive Protein/analysis
Calcitonin/*blood
Child
Child, Preschool
Community-Acquired Infections/complications/*diagnosis
Female
Humans
Infant
Infant, Newborn
Leukocyte Count
Male
Pneumonia/complications/*diagnosis
Protein Precursors/*blood
ROC Curve

Figure

• 

  Fig. 1. ROC curves of serum PCT (AUC, 0.83; 95% CI, 0.65-0.99) and CRP (AUC, 0.77; 95% CI, 0.59-0.95) levels and ESR (AUC, 0.73; 95% CI, 0.54-0.92) for the diagnosis of lobar pneumonia in hospitalized children. The area under the ROC (AUROC) for serum PCT was significantly higher than those of the CRP and ESR (P<0.01). The optimum diagnostic cutoff point for the serum PCT, CRP, ESR levels in this study was 1 ng/mL, 6 mg/L, 30 mm/hr by the ROC curve analysis. Abbreviations: PCT, procalcitonin; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; AUC, area under the curve.

Reference

1.Sinaniotis CA., Sinaniotis AC. Community-acquired pneumonia in children. Curr Opin Pulm Med. 2005. 11:218–25.

2.Assicot M., Gendrel D., Carsin H., Raymond J., Guilbaud J., Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993. 341:515–8.

3.Gendrel D., Assicot M., Raymond J., Moulin F., Francoual C., Badoual J, et al. Procalcitonin as a marker for the early diagnosis of neonatal infection. J Pediatr. 1996. 128:570–3.

4.Müller B., Christ-Crain M., Nylen ES., Snider R., Becker KL. Limits to the use of the procalcitonin level as a diagnostic marker. Clin Infect Dis. 2004. 39:1867–8.

5.Páramo JA., Orbe J. Hemostasis, inflammation and cardiovascular disease. Clin Lab. 2002. 48:463–70.

6.Reinhart K., Meisner M., Brunkhorst FM. Markers for sepsis diagnosis: what is useful? Crit Care Clin. 2006. 22:503–19. ix-x.

7.Korppi M., Remes S., Heiskanen-Kosma T. Serum procalcitonin concentrations in bacterial pneumonia in children: a negative result in primary healthcare settings. Pediatr Pulmonol. 2003. 35:56–61.

8.Moulin F., Raymond J., Lorrot M., Marc E., Coste J., Iniguez JL, et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child. 2001. 84:332–6.

9.Toikka P., Irjala K., Juvén T., Virkki R., Mertsola J., Leinonen M, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J. 2000. 19:598–602.

10.Jaye DL., Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J. 1997. 16:735–46.

11.van Rossum AM., Wulkan RW., Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis. 2004. 4:620–30.

12.British Thoracic Society Standards of Care Committee. British Thoracic Society Guidelines for the Management of Community Acquired Pneumonia in Childhood. Thorax. 2002. 57(S1):i. 1–24.

13.Sectish T., Prober CG. Pneumonia. Kliegman RM, Behrman RE, editors. Nelson textbook of pediatrics. 18th ed.Philadelphia, PA: Saunders;2007. p. 1795–800.

14.Marcos MA., Jiménez de Anta MT., de la Bellacasa JP., González J., Martínez E., García E, et al. Rapid urinary antigen test for diagnosis of pneumococcal community-acquired pneumonia in adults. Eur Respir J. 2003. 21:209–14.

15.Prat C., Domínguez J., Rodrigo C., Giménez M., Azuara M., Jiménez O, et al. Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection. Pediatr Infect Dis J. 2003. 22:963–8.

16.Korppi M., Heiskanen-Kosma T., Leinonen M. White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. Eur Respir J. 1997. 10:1125–9.

17.Korppi M., Remes S. Serum procalcitonin in pneumococcal pneumonia in children. Eur Respir J. 2001. 17:623–7.

18.Isaacs D. Problems in determining the etiology of community-acquired childhood pneumonia. Pediatr Infect Dis J. 1989. 8:143–8.

19.Courtoy I., Lande AE., Turner RB. Accuracy of radiographic differentiation of bacterial from nonbacterial pneumonia. Clin Pediatr (Phila). 1989. 28:261–4.

20.Korppi M., Kiekara O., Heiskanen-Kosma T., Soimakallio S. Comparison of radiological findings and microbial aetiology of childhood pneumonia. Acta Paediatr. 1993. 82:360–3.

21.Virkki R., Juven T., Rikalainen H., Svedström E., Mertsola J., Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax. 2002. 57:438–41.

22.Christ-Crain M., Jaccard-Stolz D., Bingisser R., Gencay MM., Huber PR., Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004. 363:600–7.

23.Simon L., Gauvin F., Amre DK., Saint-Louis P., Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004. 39:206–17.

24.Müller B., Becker KL. Procalcitonin: how a hormone became a marker and mediator of sepsis. Swiss Med Wkly. 2001. 131:595–602.

25.Don M., Valent F., Korppi M., Falleti E., De Candia A., Fasoli L, et al. Efficacy of serum procalcitonin in evaluating severity of community-acquired pneumonia in childhood. Scand J Infect Dis. 2007. 39:129–37.

26.Ip M., Rainer TH., Lee N., Chan C., Chau SS., Leung W, et al. Value of serum procalcitonin, neopterin, and C-reactive protein in differentiating bacterial from viral etiologies in patients presenting with lower respiratory tract infections. Diagn Microbiol Infect Dis. 2007. 59:131–6.

27.Fine MJ., Auble TE., Yealy DM., Hanusa BH., Weissfeld LA., Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997. 336:243–50.