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American Academy of Pediatrics
Article

Diagnostic Value of Procalcitonin in Well-Appearing Young Febrile Infants

Borja Gomez, Silvia Bressan, Santiago Mintegi, Liviana Da Dalt, Daniel Blazquez, Izaskun Olaciregui, Mercedes de la Torre, Miriam Palacios, Paola Berlese and Aitor Ruano
Pediatrics November 2012, 130 (5) 815-822; DOI: https://doi.org/10.1542/peds.2011-3575
Borja Gomez
aPediatric Emergency Department Cruces University Hospital, Barakaldo, Spain;
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Silvia Bressan
bDepartment of Pediatrics, University of Padova, Padova, Italy;
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Santiago Mintegi
aPediatric Emergency Department Cruces University Hospital, Barakaldo, Spain;
cUniversity of the Basque Country, Bizkaia, Spain;
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Liviana Da Dalt
dDepartment of Pediatrics Ca’Foncello Hospital, Treviso, Italy;
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Daniel Blazquez
eDepartment of Pediatrics 12 de Octubre University Hospital, and
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Izaskun Olaciregui
fDepartment of Pediatrics, Donostia University Hospital, Donostia, Spain;
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Mercedes de la Torre
gPediatric Emergency Department, Niño Jesús Children’s University Hospital, Madrid, Spain;
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Miriam Palacios
hDepartment of Pediatrics Navarra Hospital Complex, Pamplona, Spain; and
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Paola Berlese
bDepartment of Pediatrics, University of Padova, Padova, Italy;
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Aitor Ruano
iDepartment of Pediatrics, Basurto University Hospital, Bilbao, Spain
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Abstract

BACKGROUND AND OBJECTIVE: Procalcitonin (PCT) has been introduced in many European protocols for the management of febrile children. Its value among young, well-appearing infants, however, is not completely defined. Our objective was to assess its performance in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) in well-appearing infants aged <3 months with fever without source (FWS).

METHODS: Well-appearing infants aged <3 months with FWS admitted to 7 European pediatric emergency departments were retrospectively included. IBI was defined as the isolation of a bacterial pathogen in blood or cerebrospinal fluid culture.

RESULTS: We included 1112 infants who had PCT measured and a blood culture performed. IBI was diagnosed in 23 cases (2.1%). In the multivariate analysis including clinical and laboratory data, PCT was the only independent risk factor for IBI (odds ratio 21.69; 95% confidence interval [CI] 7.93–59.28 for PCT ≥0.5 ng/mL). Positive likelihood ratios for PCT ≥2 ng/mL and C-reactive protein (CRP) >40 mg/L were 11.14 (95% CI 7.81–15.89) and 3.45 (95% CI 2.20–5.42), respectively. Negative likelihood ratios for PCT <0.5 ng/mL and CRP <20 mg/L were 0.25 (95% CI 0.12–0.55) and 0.41 (95% CI 0.22–0.76). Among patients with normal urine dipstick results and fever of recent onset, areas under the receiver operator characteristic curve for PCT and CRP were 0.819 and 0.563, respectively.

CONCLUSIONS: Among well-appearing young infants with FWS, PCT performs better than CRP in identifying patients with IBIs and seems to be the best marker for ruling out IBIs. Among patients with normal urine dipstick results and fever of recent onset, PCT remains the most accurate blood test.

KEY WORDS
  • procalcitonin
  • fever
  • young infant
  • serious bacterial infection
  • invasive bacterial infection
  • Abbreviations:
    ANC —
    absolute neutrophil count
    CI —
    confidence interval
    CRP —
    C-reactive protein
    CSF —
    cerebrospinal fluid
    FWS —
    fever without source
    IBI —
    invasive bacterial infection
    LR —
    likelihood ratios
    PCT —
    procalcitonin
    PED —
    pediatric emergency department
    SBI —
    serious bacterial infection
    UD —
    urine dipstick
    UTI —
    urinary tract infection
    WBC —
    white blood cell
    • Accepted July 9, 2012.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 130, Issue 5
    1 Nov 2012
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    Diagnostic Value of Procalcitonin in Well-Appearing Young Febrile Infants
    Borja Gomez, Silvia Bressan, Santiago Mintegi, Liviana Da Dalt, Daniel Blazquez, Izaskun Olaciregui, Mercedes de la Torre, Miriam Palacios, Paola Berlese, Aitor Ruano
    Pediatrics Nov 2012, 130 (5) 815-822; DOI: 10.1542/peds.2011-3575

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    Diagnostic Value of Procalcitonin in Well-Appearing Young Febrile Infants
    Borja Gomez, Silvia Bressan, Santiago Mintegi, Liviana Da Dalt, Daniel Blazquez, Izaskun Olaciregui, Mercedes de la Torre, Miriam Palacios, Paola Berlese, Aitor Ruano
    Pediatrics Nov 2012, 130 (5) 815-822; DOI: 10.1542/peds.2011-3575
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    • procalcitonin
    • fever
    • young infant
    • serious bacterial infection
    • invasive bacterial infection
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