title: Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit.
abstract: To determine whether peak blood procalcitonin (PCT) measured within 48 hours of pediatric intensive care unit (PICU) admission can differentiate severe bacterial infections from sterile inflammation and viral infection and identify potential subgroups of PICU patients for whom PCT may not have clinical utility.
  
  
  
  This was a retrospective, observational study of 646 critically ill children who had PCT measured within 48 hours of admission to an urban, academic PICU. Patients were stratified into 6 categories by infection status. We compared test characteristics for peak PCT, C-reactive protein (CRP), white blood cell count (WBC), absolute neutrophil count (ANC), and % immature neutrophils. The area under the receiver operating characteristic curve was determined for each biomarker to discriminate bacterial infection.
  
  
  
  The area under the receiver operating characteristic curve was similar for PCT (0.73, 95% CI 0.69, 0.77) and CRP (0.75, 95% CI 0.71, 0.79; P = .36), but both outperformed WBC, ANC, and % immature neutrophils (P < .01 for all pairwise comparisons). The combination of PCT and CRP was no better than either PCT or CRP alone. Diagnostic patterns prone to false-positive and false-negative PCT values were identified.
  
  
  
  Peak blood PCT measured close to PICU admission was not superior to CRP in differentiating severe bacterial infection from viral illness and sterile inflammation; both PCT and CRP outperformed WBC, ANC, and % immature neutrophils. PCT appeared especially prone to inaccuracies in detecting localized bacterial central nervous system infections or bacterial coinfection in acute viral illness causing respiratory failure.
authors: Division of Critical Care Medicine, Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: LautzA@email.chop.edu.
authors: Andrew J
authors: AJ
authors: Lautz
authors: Division of Critical Care Medicine, Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Adam C
authors: AC
authors: Dziorny
authors: Division of Critical Care Medicine, Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Adam R
authors: AR
authors: Denson
authors: Division of Critical Care Medicine, Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Kathleen A
authors: KA
authors: O'Connor
authors: Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Marianne R
authors: MR
authors: Chilutti
authors: Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Rachael K
authors: RK
authors: Ross
authors: Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Jeffrey S
authors: JS
authors: Gerber
authors: Division of Critical Care Medicine, Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Scott L
authors: SL
authors: Weiss
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000097:blood* / Q000175:diagnosis; D002116:Calcitonin / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014777:Virus Diseases / Q000097:blood* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D002116:Calcitonin
keywords: PICU; biomarker; sepsis