title: Biomarkers in Pediatric Community-Acquired Pneumonia.
abstract: Community-acquired pneumonia (CAP) is an infectious disease caused by bacteria, viruses, or a combination of these infectious agents. The severity of the clinical manifestations of CAP varies significantly. Consequently, both the differentiation of viral from bacterial CAP cases and the accurate assessment and prediction of disease severity are critical for effectively managing individuals with CAP. To solve questionable cases, several biomarkers indicating the etiology and severity of CAP have been studied. Unfortunately, only a few studies have examined the roles of these biomarkers in pediatric practice. The main aim of this paper is to detail current knowledge regarding the use of biomarkers to diagnose and treat CAP in children, analyzing the most recently published relevant studies. Despite several attempts, the etiologic diagnosis of pediatric CAP and the estimation of the potential outcome remain unsolved problems in most cases. Among traditional biomarkers, procalcitonin (PCT) appears to be the most effective for both selecting bacterial cases and evaluating the severity. However, a precise cut-off separating bacterial from viral and mild from severe cases has not been defined. The three-host protein assay based on C-reactive protein (CRP), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), plasma interferon-γ protein-10 (IP-10), and micro-array-based whole genome expression arrays might offer more advantages in comparison with former biomarkers. However, further studies are needed before the routine use of those presently in development can be recommended.
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy. nicola.principi@unimi.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.affiliation: Pediatric Clinic, Department of Surgical and Biological Sciences, Università degli Studi di Perugia, Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Perugia 06129, Italy. susanna.esposito@unimi.it.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
mesh_terms: D000367:Age Factors; D015415:Biomarkers; D017714:Community-Acquired Infections / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans; D011014:Pneumonia / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D018410:Pneumonia, Bacterial / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D011024:Pneumonia, Viral / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
keywords: C-reactive protein; biomarkers; interferon-γ protein-10; procalcitonin; tumor necrosis factor-related apoptosis-inducing ligand