Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1999 Nov;81(5):417–421. doi: 10.1136/adc.81.5.417

Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count

M Hatherill 1, S Tibby 1, K Sykes 1, C Turner 1, I Murdoch 1
PMCID: PMC1718133  PMID: 10519716

Abstract

BACKGROUND—Procalcitonin has been advocated as a marker of bacterial infection.
OBJECTIVE—To evaluate diagnostic markers of infection in critically ill children, comparing procalcitonin with C reactive protein and leucocyte count in a paediatric intensive care unit (PICU).
METHODS—Procalcitonin, C reactive protein, and leucocyte count were measured in 175 children, median age 16 months, on admission to the PICU. Patients were classified as: non-infected controls (43); viral infection (14); localised bacterial infection without shock (25); bacterial meningitis/encephalitis (10); or septic shock (77). Six children with "presumed septic shock" (without sufficient evidence of infection) were analysed separately. Optimum sensitivity, specificity, predictive values, and area under the receiver operating characteristic (ROC) curve were evaluated.
RESULTS—Admission procalcitonin was significantly higher in children with septic shock (median 94.6; range 3.3-759.8 ng/ml), compared with localised bacterial infection (2.9; 0-24.3 ng/ml), viral infection (0.8; 0-4.4 ng/ml), and non-infected controls (0; 0-4.9 ng/ml). Children with bacterial meningitis had a median procalcitonin of 25.5 (7.2-118.4 ng/ml). Area under the ROC curve was 0.96 for procalcitonin, 0.83 for C reactive protein, and 0.51 for leucocyte count. Cut off concentrations for optimum prediction of septic shock were: procalcitonin > 20 ng/ml and C reactive protein > 50 mg/litre. A procalcitonin concentration > 2 ng/ml identified all patients with bacterial meningitis or septic shock.
CONCLUSION—In critically ill children the admission procalcitonin concentration is a better diagnostic marker of infection than C reactive protein or leucocyte count. A procalcitonin concentration of 2 ng/ml might be useful in differentiating severe bacterial disease in infants and children.



Full Text

The Full Text of this article is available as a PDF (99.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Assicot M., Gendrel D., Carsin H., Raymond J., Guilbaud J., Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993 Feb 27;341(8844):515–518. doi: 10.1016/0140-6736(93)90277-N. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Berger C., Uehlinger J., Ghelfi D., Blau N., Fanconi S. Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia. Eur J Pediatr. 1995 Feb;154(2):138–144. doi: 10.1007/BF01991918. [DOI] [PubMed] [Google Scholar]
  3. Browne G. J., Ryan J. M., McIntyre P. Evaluation of a protocol for selective empiric treatment of fever without localising signs. Arch Dis Child. 1997 Feb;76(2):129–133. doi: 10.1136/adc.76.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chiesa C., Panero A., Rossi N., Stegagno M., De Giusti M., Osborn J. F., Pacifico L. Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis. 1998 Mar;26(3):664–672. doi: 10.1086/514576. [DOI] [PubMed] [Google Scholar]
  5. Dandona P., Nix D., Wilson M. F., Aljada A., Love J., Assicot M., Bohuon C. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994 Dec;79(6):1605–1608. doi: 10.1210/jcem.79.6.7989463. [DOI] [PubMed] [Google Scholar]
  6. Dershewitz R. A., Wigder H. N., Wigder C. M., Nadelman D. H. A comparative study of the prevalence, outcome, and prediction of bacteremia in children. J Pediatr. 1983 Sep;103(3):352–358. doi: 10.1016/s0022-3476(83)80402-8. [DOI] [PubMed] [Google Scholar]
  7. Franz A. R., Kron M., Pohlandt F., Steinbach G. Comparison of procalcitonin with interleukin 8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infections in newborn infants. Pediatr Infect Dis J. 1999 Aug;18(8):666–671. doi: 10.1097/00006454-199908000-00003. [DOI] [PubMed] [Google Scholar]
  8. Gendrel D., Assicot M., Raymond J., Moulin F., Francoual C., Badoual J., Bohuon C. Procalcitonin as a marker for the early diagnosis of neonatal infection. J Pediatr. 1996 Apr;128(4):570–573. doi: 10.1016/s0022-3476(96)70374-8. [DOI] [PubMed] [Google Scholar]
  9. Gendrel D., Raymond J., Assicot M., Moulin F., Iniguez J. L., Lebon P., Bohuon C. Measurement of procalcitonin levels in children with bacterial or viral meningitis. Clin Infect Dis. 1997 Jun;24(6):1240–1242. doi: 10.1086/513633. [DOI] [PubMed] [Google Scholar]
  10. Hatherill M., Jones G., Lim E., Tibby S. M., Murdoch I. A. Procalcitonin aids diagnosis of adrenocortical failure. Lancet. 1997 Dec 13;350(9093):1749–1750. doi: 10.1016/s0140-6736(05)63573-8. [DOI] [PubMed] [Google Scholar]
  11. Jaye D. L., Waites K. B. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J. 1997 Aug;16(8):735–747. doi: 10.1097/00006454-199708000-00003. [DOI] [PubMed] [Google Scholar]
  12. Kite P., Millar M. R., Gorham P., Congdon P. Comparison of five tests used in diagnosis of neonatal bacteraemia. Arch Dis Child. 1988 Jun;63(6):639–643. doi: 10.1136/adc.63.6.639. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Koenig J. M., Patterson L. E., Rench M. A., Edwards M. S. Role of fibronectin in diagnosing bacterial infection in infancy. Am J Dis Child. 1988 Aug;142(8):884–887. doi: 10.1001/archpedi.1988.02150080090031. [DOI] [PubMed] [Google Scholar]
  14. Lapillonne A., Basson E., Monneret G., Bienvenu J., Salle B. L. Lack of specificity of procalcitonin for sepsis diagnosis in premature infants. Lancet. 1998 Apr 18;351(9110):1211–1212. doi: 10.1016/S0140-6736(05)79165-0. [DOI] [PubMed] [Google Scholar]
  15. Lee G. M., Harper M. B. Risk of bacteremia for febrile young children in the post-Haemophilus influenzae type b era. Arch Pediatr Adolesc Med. 1998 Jul;152(7):624–628. doi: 10.1001/archpedi.152.7.624. [DOI] [PubMed] [Google Scholar]
  16. Lieu T. A., Schwartz J. S., Jaffe D. M., Fleisher G. R. Strategies for diagnosis and treatment of children at risk for occult bacteremia: clinical effectiveness and cost-effectiveness. J Pediatr. 1991 Jan;118(1):21–29. doi: 10.1016/s0022-3476(05)81838-4. [DOI] [PubMed] [Google Scholar]
  17. Mandl K. D., Stack A. M., Fleisher G. R. Incidence of bacteremia in infants and children with fever and petechiae. J Pediatr. 1997 Sep;131(3):398–404. doi: 10.1016/s0022-3476(97)80065-0. [DOI] [PubMed] [Google Scholar]
  18. Marzouk O., Bestwick K., Thomson A. P., Sills J. A., Hart C. A. Variation in serum C-reactive protein across the clinical spectrum of meningococcal disease. Acta Paediatr. 1993 Sep;82(9):729–733. doi: 10.1111/j.1651-2227.1993.tb12547.x. [DOI] [PubMed] [Google Scholar]
  19. McCarthy P. L., Sharpe M. R., Spiesel S. Z., Dolan T. F., Forsyth B. W., DeWitt T. G., Fink H. D., Baron M. A., Cicchetti D. V. Observation scales to identify serious illness in febrile children. Pediatrics. 1982 Nov;70(5):802–809. [PubMed] [Google Scholar]
  20. Mermel L. A., Maki D. G. Detection of bacteremia in adults: consequences of culturing an inadequate volume of blood. Ann Intern Med. 1993 Aug 15;119(4):270–272. doi: 10.7326/0003-4819-119-4-199308150-00003. [DOI] [PubMed] [Google Scholar]
  21. Monneret G., Labaune J. M., Isaac C., Bienvenu F., Putet G., Bienvenu J. Procalcitonin and C-reactive protein levels in neonatal infections. Acta Paediatr. 1997 Feb;86(2):209–212. doi: 10.1111/j.1651-2227.1997.tb08870.x. [DOI] [PubMed] [Google Scholar]
  22. Moscovitz H., Shofer F., Mignott H., Behrman A., Kilpatrick L. Plasma cytokine determinations in emergency department patients as a predictor of bacteremia and infectious disease severity. Crit Care Med. 1994 Jul;22(7):1102–1107. doi: 10.1097/00003246-199407000-00009. [DOI] [PubMed] [Google Scholar]
  23. Pollard A. J., DeMunter C., Nadel S., Levin M. Abandoning empirical antibiotics for febrile children. Lancet. 1997 Sep 13;350(9080):811–812. doi: 10.1016/S0140-6736(05)62604-9. [DOI] [PubMed] [Google Scholar]
  24. Stamos J. K., Shulman S. T. Abandoning empirical antibiotics for febrile children. Lancet. 1997 Jul 12;350(9071):84–84. doi: 10.1016/S0140-6736(05)61812-0. [DOI] [PubMed] [Google Scholar]
  25. Stanley T. V., Barrett D., Salmond C. E. Viral and bacterial infection in childhood: the value of C reactive protein. N Z Med J. 1991 Apr 10;104(909):138–139. [PubMed] [Google Scholar]
  26. Sáez-Llorens X., McCracken G. H., Jr Sepsis syndrome and septic shock in pediatrics: current concepts of terminology, pathophysiology, and management. J Pediatr. 1993 Oct;123(4):497–508. doi: 10.1016/s0022-3476(05)80942-4. [DOI] [PubMed] [Google Scholar]
  27. Weirich E., Rabin R. L., Maldonado Y., Benitz W., Modler S., Herzenberg L. A., Herzenberg L. A. Neutrophil CD11b expression as a diagnostic marker for early-onset neonatal infection. J Pediatr. 1998 Mar;132(3 Pt 1):445–451. doi: 10.1016/s0022-3476(98)70018-6. [DOI] [PubMed] [Google Scholar]
  28. Wittler R. R., Cain K. K., Bass J. W. A survey about management of febrile children without source by primary care physicians. Pediatr Infect Dis J. 1998 Apr;17(4):271–279. doi: 10.1097/00006454-199804000-00002. [DOI] [PubMed] [Google Scholar]
  29. de Werra I., Jaccard C., Corradin S. B., Chioléro R., Yersin B., Gallati H., Assicot M., Bohuon C., Baumgartner J. D., Glauser M. P. Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations: comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Crit Care Med. 1997 Apr;25(4):607–613. doi: 10.1097/00003246-199704000-00009. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES