Table 3.
Main publications of the use of procalcitonin in pediatric infection/sepsis
| Authors | Type of publication | Methods and main results | Conclusion |
|---|---|---|---|
| Rey et al.(27) | Observational prospective cohort | 359 patient-days included in the study
Evaluation of the use of PCT, CRP and leukocyte count to classify: absence of infection, SRIS, localized infection, sepsis, severe sepsis and septic shock Area under the receiver operating characteristic (ROC) curve for diagnosis of sepsis was 0.532 for leukocyte count, 0.75 for CRP and 0.912 for PCT |
PCT is a better diagnostic marker for
sepsis in critically ill patients than CRP PCT and CRP may be useful as clinical tools to stratify the severity of patients with SRIS |
| Fioretto et al.(28) | Prospective cohort | 87 patients (46 patients diagnosed
with sepsis and 41 patients diagnosed with septic shock)
PCT and CRP measurement on admission and 12 hours later |
PCT was better than CRP for the diagnosis of sepsis and septic shock, particularly on admission, and was related to disease severity |
| England et al.(29) | Systematic review | 7 studies of 2,317 patients Evaluation of the use of PCT in the diagnosis of severe bacterial infection in young infants (≤3 months of age) 5 of 7 studies used the same cut-off value (0.3ng/mL) RR for diagnosis of severe bacterial infection with increased PCT was 3.97 RR for diagnosis of severe bacterial infection using clinical prediction was 30.6 (patients without antibiotic treatment) and 8.75 (patients using antibiotic) |
PCT values < 0.3ng/mL may be useful in the exclusion of severe bacterial infection, as an additional test to clinical prediction, remaining as a key factor to guide the therapeutic approach in these patients |
| Arkader et al.(30) | Observational prospective cohort | PCT and CRP kinetics studied in
patients undergoing heart surgery with cardiopulmonary bypass
(Group 1 - SRIS) and in patients with confirmed bacterial sepsis
(Group 2) The area under the ROC curve was 0.99 for PCT and 0.54 for CRP |
PCT was able to differentiate patients
with SRIS and sepsis, and CRP was not PCT concentrations varied according to the progression of sepsis |
| Han et al.(31) | Prospective cohort | 87 patients with sepsis and septic
shock 12 critically ill patients with no criteria for sepsis PCT values were elevated in patients with bacterial sepsis at days 1 and 3 of pediatric ICU admission Persistently elevated PCT values were found in patients with bacterial sepsis with persistent multiple organ failure and in those who died, but not in patients with non-bacterial sepsis (fungal, viral or sepsis with negative culture) |
PCT is persistently elevated in children with bacterial sepsis and poor prognosis |
| Hu et al.(34) | Prospective cohort | Investigation of the relationship
between the PCT SL and prognosis in children with bacterial
meningitis 82 patients included Patients with bacterial meningitis have higher PCT SL than those with viral meningitis PCT SL were significantly higher in patients with severe sepsis and septic shock than in patients with non-severe sepsis and without sepsis A drop in PCT SL was observed in patients with a good response to antibiotic treatment PCT SL were significantly higher in patients who died than in survivors |
PCT SL are related to disease severity
in children with bacterial meningitis A decrease in PCT SL after treatment may indicate a favorable prognosis |
| Henry et al.(35) | Systematic review | 8 studies were included (616 patients)
PCT SL were highly accurate in differentiating the diagnostic etiology of meningitis in children, with 96% sensitivity and 89% specificity In 6 studies, the accuracy of PCT was higher than that of CRP |
PCT SL are highly accurate in differentiating bacterial meningitis from viral meningitis in children |
| Hatzistilianou et al.(37) | Prospective cohort | Assessment of PCT, CRP, TNF-alpha,
IL-1b, IL-8 and TNF-receptor II values in the rapid and early
diagnosis of infection in patients with acute lymphocytic
leukemia and febrile neutropenia and differentiation between
bacterial and viral infection The SL of biomarkers were assessed on admission and for 7 consecutive days PCT SL were significantly different between bacterial and non-bacterial episodes, with 94% sensitivity and 96.5% specificity |
Serial PCT measurements may be useful in predicting severe sepsis in patients with acute lymphoid leukemia and febrile neutropenia |
| Zurek et al.(43) | Prospective cohort | 62 patients (0 - 19 years) with SRIS
or sepsis were included Severity measured using the PELOD PCT SL were measured from day 1 to day 5 of admission and significantly higher PCT values were found in patients with PELOD >12 than with PELOD < 12 |
PCT SL from day 1 to day 5 of pediatric ICU admission are related to severity and multiple organ dysfunction in children with SRIS/sepsis |
PCT - procalcitonin; CRP - C-reactive protein; SRIS - systemic inflammatory response syndrome; RR - relative risk; SL - serum levels; TNF-alpha - Tumor necrosis factor alpha; IL-1b-interleukin 1 beta; IL-8 interleukin 8; TNF-receptor II - tumor necrosis factor receptor II; PELOD - Pediatric Logistic Organ Dysfunction score.