Procalcitonin and C-reactive protein as predictors of blood culture positivity among hospitalised children with severe pneumonia in Mozambique.
OBJECTIVE
To evaluate the benefits of using procalcitonin (PCT) and C-reactive protein (CRP) as pre-screening tools to predict blood culture positivity among Mozambican children with clinical severe pneumonia (CSP).


METHODS
586 children <5 years with CSP and no concurrent malaria fulfilled criteria to be included in the study groups. We determined PCT and CRP for all children with positive bacterial culture (BC+ group, n = 84) and of a random selection of children with negative bacterial culture (BC- group, n = 246).


RESULTS
PCT and CRP levels were higher in the BC+ group than the BC- one (PCT: median 7.73 versus 0.48 ng/ml, P < 0.001; CRP: 177.65 mg/l vs. 26.5 mg/l, P < 0.001). In multivariate analysis, PCT was the only independent predictor of the group. To be used as pre-screening tool, PCT presented higher specificities for predetermined sensitivities (≥85%) than CRP. Pursuing a sensitivity of 95%, PCT could reduce the need for bacterial culture by 49% and overall diagnosis costs by 7-35% [assuming variable costs for PCT measurement (ranging from 10 to 30 USD) and a fixed cost of 72.5 USD per blood culture].


CONCLUSIONS
Among hospitalised children with CSP and absence of concurrent malaria, PCT pre-screening could help reduce the number of blood cultures and diagnosis costs by specifically targeting patients more likely to yield positive results.
Barcelona Centre for International Health Research, Universitat de Barcelona, Spain.
N
N
Díez-Padrisa
Q
Q
Bassat
L
L
Morais
C
C
O'Callaghan-Gordo
S
S
Machevo
T
T
Nhampossa
A B
AB
Ibarz-Pavón
L
L
Quintó
P L
PL
Alonso
A
A
Roca
D016470:Bacteremia / Q000175:diagnosis*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis* / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000175:diagnosis; D011498:Protein Precursors / Q000097:blood*; D012720:Severity of Illness Index
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide