Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection.
BACKGROUND
Lower respiratory tract infection is the most common infection leading to unnecessary antibiotic treatment in children. Etiologic diagnosis is not immediately achieved, and the pathogen remains unidentified in a large number of cases. Neither clinical nor laboratory factors allow for a rapid distinction between bacterial and viral etiology. The aim of our study was to evaluate the reliability of procalcitonin (PCT), C-reactive protein (CRP) and leukocyte count in distinguishing pneumococcal, atypical and viral lower respiratory tract infection.


METHODS
PCT, CRP and leukocyte count were measured in children with microbiologically documented diagnoses of lower respiratory tract infection. The results were compared of children with pneumococcal, atypical and viral etiologies.


RESULTS
PCT and CRP showed significant correlation with a bacterial etiology of lower respiratory tract infection. No significance was found for leukocyte count. Using a cutoff point of 2 ng/ml for PCT and 65 mg/l for CRP, the sensitivities and specificities for distinguishing bacterial from viral lower respiratory tract infections were 68.6 and 79.4% for PCT and 79.1 and 67.1% for CRP. The sensitivities and specificities for distinguishing pneumococcal from other etiologies were 90.3 and 74.1% for PCT and 90.3 and 60% for CRP, respectively.


CONCLUSIONS
High PCT and CRP values show a significant correlation with the bacterial etiology of lower respiratory tract infection. PCT and CRP show good sensitivity for distinguishing pneumococcal from other etiologies. PCT shows higher specificity than CRP. PCT and CRP can help make decisions about antibiotic therapy in children with lower respiratory tract infections.
Prat
Cristina
C
Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, C/Canyet s/n, 08916 Badalona, Spain. crisprat@ns.hugtip.scs.es
Domínguez
Josep
J
Rodrigo
Carlos
C
Giménez
Montse
M
Azuara
Marta
M
Jiménez
Orlando
O
Galí
Núria
N
Ausina
Vicenç
V
D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000032:analysis*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000032:analysis*; D012372:ROC Curve; D012141:Respiratory Tract Infections / Q000097:blood / Q000382:microbiology*; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide