Table 4.
PCT in other situations.
| Study | Type | Population | n | Age | Aim | Conclusions |
|---|---|---|---|---|---|---|
| Stocker (2010)54 | P, I | NICU, GA > 34, suspected of early onset sepsis | 121 | <3 d | PCT-guided decision-making on antibiotic | Serial PCT measurements allowed shortening the duration of empiric antibiotic therapy 22.4 h. The age-adjusted PCT nomogram with a safety cutoff value of 10 ng/mL seems to be reasonable. |
| Kordek (2003)57 | P | NICU, all newborns (preterm and term) | 187 | Umbilical cord | PCT for diagnosis of intrauterine IBI | AUC, 0.75 PCT cutoff 1.2 ng/mL, Sn 69%, Sp 81%, PPV 42%, NPV 93%. PCT in preterm infants with IBI is significantly higher than in term neonates. |
| Chiesa (1998)58 | P | NICU, all newborns (preterm and term) | 318 143 sepsis 175 controls |
0-48 h 3-30 d |
PCT for diagnosis early and late-onset sepsis | PCT can be a marker of early onset sepsis. PCT for early detection of late-onset infections and for monitoring the follow-up of clinical course. |
| Hemming (2017)69 | P | Febrile neutropenia in children with cancer | 48 episodes | 0-18 y | PCT for diagnosis severe IBI | PCT > 2 ng/mL is associated with increased risk of severe infection. Data suggest that the clinical decision rules are largely ineffective in risk stratification. |
| Fleischhack (2000)70 | R | Febrile neutropenia in children with cancer | 122 episodes | 0.7-31.8 y | PCT to detected IBI. PCT to monitor response to antibiotic | PCT cutoff 0.5 ng/mL, Sn 60%, Sp 85%. PCT was superior to other parameters in the early detection of gram-negative bacteraemia and fever of unknown origin. |
| Ozsurekci (2016)75 | P | Fever with unknown focus and a central venous catheter | 62 | 1 mo-18 y | PCT for diagnosis of catheter-related bloodstream infections | AUC 0.68, PCT cutoff 1.18 ng/mL, Sn 71%, Sp 80%, PPV 77%, NPV 74%. PCT may be a useful rapid diagnostic biomarker for suspected catheter-related bloodstream infections. |
| Butbul-Aviel (2005)61 | — | ED Child with fever and limp | 44 | 15 d-19 y | PCT for diagnosis of osteomyelitis and septic arthritis | Clinical diagnosis, pus and culture. PCT cutoff 0.5 ng/mL, Sn 43.5%, Sp 100%, PPV 100%. PCT as a useful marker in the diagnosis of osteomyelitis but not in septic arthritis. |
| Bobillo (2018)78 | P | PICU, assisted with ECMO | 40 | <18 y | Kinetics of PCT and its relationship with morbidity and mortality | PCT could be useful in the same situations as in patients without ECMO. |
| Sariego-Jamardo (2017)38 | P | PICU After different types of surgery |
115 | — | Kinetics of PCT increase above the suggested cutoff level for PCT for the diagnosis of sepsis | PCT showed an early peak at 24 h after surgery with a rapid decrease. PCT showed no increase after clean and clean-contaminated surgery. PCT seems to be a useful tool to guide diagnosis and antibiotic approach to nosocomial sepsis in the postoperative period |
| Launes (2016)95 | P | PICU Bacterial nosocomial infection confirmed by cultures |
96 | 1 mo-18 y | To analyze results after implementation of antibiotics de-escalation protocol guided by PCT | Protocol of stewardship: PCT decreasing >50% in comparison with its value at diagnosis, or <0.5 ng/mL. After the implementation of the protocol, 75% of the children were treated for 10 days, compared with 14 days of the pre-implementation period. PCT-guided protocol reduced the exposure to antibiotics in nosocomial infections without adverse outcomes. |
| Rungatscher (2013)63 | P | PICU, assisted with veno-arterial ECMO | 20 | <2 y | PCT for predicting infection, organ dysfunction, and clinical outcome | Higher PCT values in patients non-infected (Infected, 2.4 ng/mL and non- infected, 8.8 ng/mL). Higher PCT values in patients with multi-organ dysfunction (10.9 vs 1.85 ng/mL). |
| Davidson (2013)40 | P | CICU After CS |
69 | <3 mo | Kinetics of PCT | PCT rises after cardiothoracic surgery but decreases by 72 h. Higher PCT levels at 72 h are independently associated with increased circulatory support at 72 h and a trend toward increased length of intubation. PCT may be better than CRP as a sepsis biomarker. |
Abbreviations: AUC, area under the curve; CICU, cardiac intensive care unit; CRP, C-reactive protein; CS, cardiothoracic surgery; ECMO, extracorporeal membrane oxygenation; ED, emergency department; GA, gestational age; I, interventional study; IBI, invasive bacterial infection; NICU, neonatal intensive care unit; NPV, negative predictive value; P, prospective study; PCT, procalcitonin; PICU, pediatric intensive care unit; R, retrospective study; Sn, sensitivity; Sp, specificity.