RT Journal Article
SR Electronic
T1 Diagnostic Value of Procalcitonin in Well-Appearing Young Febrile Infants
JF Pediatrics
JO Pediatrics
FD American Academy of Pediatrics
SP 815
OP 822
DO 10.1542/peds.2011-3575
VO 130
IS 5
A1 Gomez, Borja
A1 Bressan, Silvia
A1 Mintegi, Santiago
A1 Da Dalt, Liviana
A1 Blazquez, Daniel
A1 Olaciregui, Izaskun
A1 de la Torre, Mercedes
A1 Palacios, Miriam
A1 Berlese, Paola
A1 Ruano, Aitor
YR 2012
UL http://pediatrics.aappublications.org/content/130/5/815.abstract
AB 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.Abbreviations:ANC — absolute neutrophil countCI — confidence intervalCRP — C-reactive proteinCSF — cerebrospinal fluidFWS — fever without sourceIBI — invasive bacterial infectionLR — likelihood ratiosPCT — procalcitoninPED — pediatric emergency departmentSBI — serious bacterial infectionUD — urine dipstickUTI — urinary tract infectionWBC — white blood cell