Procalcitonin to Detect Suspected Bacterial Infections in the PICU

Mandell, Iris; Aghamohammadi, Sara; Deakers, Timothy; Khemani, Robinder G.

doi:10.1097/pcc.0000000000000571

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…19 Although that study was performed prospectively, only 33% (n=107) of eligible patients were included in the primary analysis, and most of the patients with incorrect PCT classification were false-positive rather than false-negative results (ie, PCT was more useful to “rule-out” rather than “rule-in” bacterial infection). Also, patients were categorized without regard to shock by Mandell et al and 25.7% of patients without bacterial infection required inotropic support.…”

Section: Discussionmentioning

confidence: 99%

“…Prior pediatric studies have reported mixed results, and few studies have specifically examined the use of PCT in the pediatric intensive care unit (PICU). 16–19 In some cases, PCT has yielded superior test characteristics than routinely used laboratory tests, such as measurement of C-reactive protein (CRP), white blood cell count (WBC), and percentage immature neutrophils (% Imm), but the optimal cut-point reported for PCT to guide clinical decision-making remains highly variable across studies. 20–24 One common limitation of prior studies has been the relatively small sample size of subjects analyzed.…”

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confidence: 99%

“…Along these lines, one recently published prospective study suggested that there may be subgroups of patients in the PICU for whom PCT measurement is less useful, but the study but had too few patients to draw firm conclusions. 19 …”

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confidence: 99%

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Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit

Lautz

Dziorny

Denson

et al. 2016

The Journal of Pediatrics

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Objectives To determine whether peak blood PCT measured within 48 hours of pediatric intensive care unit (PICU) admission can differentiate severe bacterial infections from sterile inflammation and viral infection and identify potential subgroups of PICU patients for whom PCT may not have clinical utility. Study design This was a retrospective, observational study of 646 critically ill children who had PCT measured within 48 hours of admission to an urban, academic PICU. Patients were stratified into 6 categories by infection status. We compared test characteristics for peak PCT, C-reactive protein (CRP), white blood cell count (WBC), absolute neutrophil count (ANC), and percentage immature neutrophils (% Imm). The area under the receiver operating characteristic curve (AUROC) was determined for each biomarker to discriminate bacterial infection. Results The AUROC was similar for PCT (0.73, 95% CI 0.69, 0.77) and CRP (0.75, 95% CI 0.71, 0.79; p=0.36), but both outperformed WBC, ANC, and % immature neutrophils (p<0.01 for all pairwise comparisons). The combination of PCT and CRP was no better than either PCT or CRP alone. Diagnostic patterns prone to false-positive and false-negative PCT values were identified. Conclusions Peak blood PCT measured close to PICU admission was not superior to CRP in differentiating severe bacterial infection from viral illness and sterile inflammation; both PCT and CRP outperformed WBC, ANC, and % immature neutrophils. PCT appeared especially prone to inaccuracies in detecting localized bacterial central nervous system infections or bacterial co-infection in acute viral illness causing respiratory failure.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit

Lautz

Dziorny

Denson

et al. 2016

The Journal of Pediatrics

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“…Serial PCT concentrations have been recently studied (by Mandell et al 15 in 2016) in the pediatric population in regard to sepsis. They suggested that patients with confirmed viral infections in the absence of bacterial infections demonstrated rising PCT concentrations and concluded that the trend in PCT concentrations could not accurately be used to predict the presence or absence of bacterial infection.…”

Section: Bacteroides Tectum 1 (3)mentioning

confidence: 99%

Association of Procalcitonin Value and Bacterial Coinfections in Pediatric Patients With Viral Lower Respiratory Tract Infections Admitted to the Pediatric Intensive Care Unit

Kotula¹,

Moore²,

Cies³

2018

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVE Our primary objective was to determine the utility of procalcitonin (PCT) in detection of bacterial coinfection in children < 5 years admitted to the pediatric intensive care unit with viral lower respiratory tract infection (LRTI).METHODS Electronic medical record review of children < 5 years admitted to the pediatric intensive care unit with a viral LRTI who also had at least 1 PCT concentration measurement. RESULTS Seventy-five patients were admitted to the intensive care unit and met the inclusion criteria for this investigation. The PCT threshold concentrations of 0.9, 1, 1.4, and 2 ng/mL were found to be statistically significant in determining the presence of a bacterial coinfection. The PCT concentration with the most utility was 1.4 ng/mL with sensitivity, specificity, positive and negative predictive values of 46%, 83%, 68%, and 76%, respectively. For patients with serial PCTs, the second PCT correctly influenced treatment decisions for 11 of 25 patients (44%). CONCLUSIONS A PCT value of 1.4 ng/mL determined the presence of a bacterial coinfection primarily owing to the high specificity and negative predictive value. Our data add evidence to the relatively high negative predictive value of PCT concentrations in identifying patients with bacterial coinfection, specifically in the case of viral LRTI. In addition, our preliminary data indicate serial PCT measurements may help further influence correct treatment decisions. Prospective, controlled studies are warranted to validate an appropriate PCT threshold concentration to help in identifying bacterial coinfection as well as to further explore the role of serial PCT values in determining the absence or presence of a bacterial coinfection. ABBREVIATIONS CXR, chest radiograph; ICU, intensive care unit; LOS, length of stay; LRTI, lower respiratory tract infections; PCT, procalcitonin; PICU, pediatric intensive care unit

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“…13 In a prospective, observational study of 144 critically ill children with suspected bacterial infections, PCT levels were higher in those with confirmed bacterial infections as compared with those with low suspicion for bacterial infection. 14 However, no large-scale studies of the diagnostic accuracy of serum PCT for bacteremia alone have been performed in febrile, critically ill, pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Accuracy of Serum Procalcitonin for Bacteremia in Critically Ill Children

Nellis

Pon

Giambrone

et al. 2016

Infect Dis Clin Pract

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Background Bacterial sepsis is frequently encountered in children admitted to the Pediatric Intensive Care Unit (PICU) and requires early recognition and treatment. Procalcitonin (PCT) is a serum biomarker with a high sensitivity to predict bacteremia in critically-ill adults. This study sought to evaluate the diagnostic accuracy of PCT for bacteremia in febrile children in the PICU. Methods This retrospective observational study used data from children admitted to the PICU from October 2010 to October 2012. Patients up to 21 years of age were included if they had an abnormal temperature, serum PCT and blood culture assayed, and were not receiving empiric antibiotics at the time. Results There were 202 PCT values that met inclusion criteria. The prevalence of positive blood cultures was 13.2% (27 total positive blood cultures). The area under the curve (AUC) for PCT was 0.79 (95% CI, 0.70-0.89), the AUC for lactate was 0.76 (95% CI, 0.65-0.87), and the AUC for C-reactive protein was 0.68 (95% CI, 0.57-0.80). The optimal threshold of PCT for accuracy was determined to be 2 ng/mL (sensitivity = 69.2%, specificity = 74.4%, positive predictive value = 28.6%, negative predictive value = 94.2%). The combination of an abnormal lactate (> 2.0mmol/L) increased the specificity of PCT for diagnosing bacteremia. Conclusions PCT has a good diagnostic accuracy to rule-out bacteremia in critically-ill, febrile children. The combination of PCT and an abnormal lactate value increases the specificity and may improve the ability to diagnose bacteremia.

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Procalcitonin to Detect Suspected Bacterial Infections in the PICU

Cited by 16 publications

References 15 publications

Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit

Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit

Association of Procalcitonin Value and Bacterial Coinfections in Pediatric Patients With Viral Lower Respiratory Tract Infections Admitted to the Pediatric Intensive Care Unit

The Diagnostic Accuracy of Serum Procalcitonin for Bacteremia in Critically Ill Children

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