Diagnostic test accuracy of point-of-care procalcitonin to diagnose serious bacterial infections in children
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RESEARCH ARTICLE
Open Access
Diagnostic test accuracy of point-of-care procalcitonin to diagnose serious bacterial infections in children Thomas Waterfield1,2*, Julie-Ann Maney1, Mark D Lyttle3,4, James P McKenna5, Damian Roland6,7, Michael Corr8, Bethany Patenall9, Michael D Shields2, Kerry Woolfall10, Derek Fairley2,5 and On behalf of Paediatric Emergency Research in the UK and Ireland (PERUKI)
Abstract Background: The National Institute for Health and Care Excellence (NICE) have called for research into the role of biomarkers, and specifically procalcitonin (PCT), for the early diagnosis of serious bacterial infections (SBI) in children. The aim of this study was to compare the diagnostic test accuracy of C-reactive protein (CRP) and PCT for the diagnosis of SBI in children. Methods: Data was collected prospectively from four UK emergency departments (ED) between November 2017 and June 2019. Consecutive children under 18 years of age with fever and features of possible sepsis and/or meningitis were eligible for inclusion. The index tests were PCT and CRP and the reference standard was the confirmation of SBI. Results: 213 children were included in the final analysis. 116 participants (54.5%) were male, and the median age was 2 years, 9 months. Parenteral antibiotics were given to 100 (46.9%), three (1.4%) were admitted to a paediatric intensive care unit and there were no deaths. There were ten (4.7%) confirmed SBI. The area under the curve for PCT and CRP for the detection of SBI was identical at 0.70. Conclusions: There was no difference in the performance of PCT and CRP for the recognition of SBI in this cohort. Trial registration: Registered at https://www.clinicaltrials.gov (trial registration: NCT03378258) on the 19th of December 2017. Keywords: Procalcitonin, infection, paediatrics, bacterial infection, biomarkers
Background Serious bacterial infections (SBI) can be difficult to distinguish from many self-limiting benign viral infections affecting children, especially during the prodrome. When the diagnosis is unclear, clinicians may use biomarkers, such as C-reactive protein (CRP) and procalcitonin * Correspondence: [email protected] 1 Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK 2 Centre for Experimental Medicine, Wellcome Wolfson Institute of Experimental Medicine, Queen’s University Belfast, Belfast, UK Full list of author information is available at the end of the article
(PCT), to aid clinical decision-making [1]. Procalcitonin is the precursor for calcitonin and is produced by parafollicular cells [2, 3]. It is a 116-amino acid protein that has roles in calcium metabolism [4]. PCT is elevated during infection and typically rises within two hours of the onset of a bacterial infection reaching a peak at 24 to 36 hours [4]. Procalcitonin levels are attenuated by the presence of interferon gamma that is typically released during viral infections leading to suggestions that PCT may have uses in distinguishing viral from bacterial infections [4].
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