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Abstract
Background:
Community-acquired pneumonia (CAP) is a common respiratory disorder in children, which necessitates hospitalization. Bacterial pneumonia, especially lobar pneumonia and parapneumonic effusions, is associated with considerably severe clinical course and extensive alveolar infiltrates. Serum procalcitonin (PCT) level has been used to distinguish bacterial from viral infections, but its usefulness is disputed. The diagnostic accuracy and usefulness of PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count were determined by comparing their values in the patients with CAP with those in healthy controls.
Methods:
The serum PCT levels, as well as CRP level, ESR, and WBC counts, were measured in 76 hospitalized patients with CAP (lobar pneumonia, 16; bronchopneumonia, 60) and 18 healthy controls. Serum PCT level was measured using VIDAS® BRAHMS PCT (Biomerieux, France), and ROC curve analysis was performed to evaluate its diagnostic accuracy.
Results:
Serum PCT levels were higher in the patients with CAP than in healthy controls, especially in the patients with lobar pneumonia than in those with bronchopneumonia. Serum CRP level was also significantly elevated in the patients with CAP, especially in those with lobar pneumonia. The diagnostic accuracy of serum PCT level for the diagnosis of lobar pneumonia was better than those of serum CRP level and ESR. The serum PCT level was significantly correlated with the CRP level, ESR, and WBC count.
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Fig. 1.
ROC curves of serum PCT (AUC, 0.83; 95% CI, 0.65-0.99) and CRP (AUC, 0.77; 95% CI, 0.59-0.95) levels and ESR (AUC, 0.73; 95% CI, 0.54-0.92) for the diagnosis of lobar pneumonia in hospitalized children.
The area under the ROC (AUROC) for serum PCT was significantly higher than those of the CRP and ESR (P<0.01). The optimum diagnostic cutoff point for the serum PCT, CRP, ESR levels in this study was 1 ng/mL, 6 mg/L, 30 mm/hr by the ROC curve analysis.
Abbreviations: PCT, procalcitonin; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; AUC, area under the curve.
Table 1.
Serum levels of PCT and inflammatory markers in the entire study group
| Patients with pneumonia (N=76) | Control (N=18) | P value | |
|---|---|---|---|
| Mean age (months) | 39 | 53 | |
| Number of males | 36 | 9 | |
| PCT (ng/mL) | 2.06±0.60 | 0.05±0.02 | 0.002 |
| <2 yr old | 0.17±0.03 | - | |
| 2-5 yr old | 1.48±0.74 | - | |
| >5 yr old | 4.14±1.41 | - | 0.01∗ |
| CRP (mg/L) | 8.00±0.75 | 0.35±0.00 | 0.01 |
| WBC (×103/μL) | 12.8±0.6 | 9.7±0.6 | 0.01 |
| PCT level | |||
| <0.5 ng/mL, n (%) | 53 (70) | 18 (100) | 0.007† |
| ≥0.5 ng/mL, n (%) | 23 (30) | 0 (0) |
Table 2.
Serum levels of PCT and inflammatory markers according to the types of pneumonia
| Bronchopneumonia (N=60) | Lobar pneumonia (N=16) | P value | |
|---|---|---|---|
| PCT (ng/mL) | 1.13±0.53 | 5.19±0.74 | 0.04 |
| CRP (mg/L) | 6.7±0.68 | 12.27±2.17 | 0.03 |
| ESR (mm/h) | 21.2±2.0 | 32.4±3.8 | 0.04 |
| WBC (×103/μL) | 12.42±0.62 | 14.59±1.76 | 0.23 |
| PCT level | |||
| <0.5 ng/mL, n (%) | 45 (75) | 6 (38) | 0.007∗ |
| ≥0.5 ng/mL, n (%) | 15 (25) | 10 (62) |
Table 3.
Diagnostic accuracies of serum PCT, CRP levels and ESR in the patients with lobar pneumonia
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