1887

Abstract

Purpose. To compute diagnostic test properties of C-reactive protein (CRP) and serum procalcitonin (PCT) levels in bloodstream infections in children with cancer and suspected sepsis, in comparison with blood culture as the gold standard.

Methodology. Consecutive paediatric cancer patients, aged ≤14 years, with clinically suspected bloodstream infections were evaluated with blood culture and assay of PCT and CRP levels. Blood culture was taken as the gold standard for comparison. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and receiver operating characteristic (ROC) with area under ROC curve (AUC) were calculated to assess the diagnostic test performance for PCT and CRP.

Results/Key findings. The ROC curve for PCT was better than that for CRP, with an AUC of 0.751 for PCT at a cut-off of 2.25 ng ml. The AUC for CRP was 0.638 at a cut-off of 8.0 mg dl. Among the three cut-off values of PCT selected from the ROC curve applicable to the patients under study, the cut-off value of ≥0.49 ng ml had the maximum sensitivity of 81.4 % and an NPV of 94.67 %; ≥2.25 ng ml had a sensitivity and specificity of 65.12 and 71.6 %, respectively, and ≥6.47 ng ml had a maximum specificity of 82.10 %. For CRP, the cut-off value of ≥5.3 mg dl had the maximum sensitivity of 72.09 %; ≥8.0 mg dl had a sensitivity and specificity of 58.14 and 68.09 %, respectively, and ≥8.4 mg dl had the maximum specificity of 70.04 %.

Conclusion. PCT is a better serological marker for excluding bloodstream infections than CRP. The cut-off value of 0.49 ng ml with a negative predictive value of 94.67 % will be ideal in a clinical setting of immune-compromised children with suspected sepsis.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000478
2017-05-15
2019-10-16
Loading full text...

Full text loading...

/deliver/fulltext/jmm/66/5/622.html?itemId=/content/journal/jmm/10.1099/jmm.0.000478&mimeType=html&fmt=ahah

References

  1. Pizzo PA, Poplack DG. Chapter 40, Infectious complications in pediatric cancer patients. In: Principles and Practice of Pediatric Oncology, 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2010; pp.1190–1235
    [Google Scholar]
  2. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med 2011;9:107 [CrossRef][PubMed]
    [Google Scholar]
  3. WHO 2015; C-reactive protein concentrations as a marker of inflammation or infection for interpreting biomarkers of micronutrient status. http://apps.who.int/iris/bitstream/10665/133708/1/WHO_NMH_NHD_EPG_14.7_eng.pdf?ua=1 [accessed 12 October 2015]
  4. Hengst JM. The role of C-reactive protein in the evaluation and management of infants with suspected sepsis. Adv Neonatal Care 2003;3:3–13 [CrossRef][PubMed]
    [Google Scholar]
  5. Maruna P, Nedelníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res 2000;49:S57–S61[PubMed]
    [Google Scholar]
  6. Schuetz P. 2015; Clinical guide to use procalcitonin for diagnosis and guidance of antibiotic therapy. www.biomerieux-diagnostics.com/sites/clinic/files/pct_booklet_-_bmx_-_final.pdf [accessed 12 October 2015]
  7. Hur M, Moon HW, Yun YM, Kim KH, Kim HS et al. Comparison of diagnostic utility between procalcitonin and C-reactive protein for the patients with blood culture-positive sepsis. Korean J Lab Med 2009;29:529–535 [CrossRef][PubMed]
    [Google Scholar]
  8. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004;39:206–217 [CrossRef][PubMed]
    [Google Scholar]
  9. Riedel S, Melendez JH, An AT, Rosenbaum JE, Zenilman JM. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol 2011;135:182–189 [CrossRef][PubMed]
    [Google Scholar]
  10. Ali AM, Elkhatib WF, Abdelaziz SS. Procalcitonin versus C-reactive protein in neonatal sepsis. J Immunol Infect Dis 2014;1:1–5 [CrossRef]
    [Google Scholar]
  11. Aslan O, Afsar I, Demir M, Sener AG, Koseoglu M. Procalcitonin and C-reactive protein levels according to blood culture results in intensive care unit patients. Infect Dis Clin Pract 2014;22:267–270 [CrossRef]
    [Google Scholar]
  12. Leli C, Ferranti M, Marrano U, Al Dhahab ZS, Bozza S et al. Diagnostic accuracy of presepsin (sCD14-ST) and procalcitonin for prediction of bacteraemia and bacterial DNAaemia in patients with suspected sepsis. J Med Microbiol 2016;65:713–719 [CrossRef][PubMed]
    [Google Scholar]
  13. Dornbusch HJ, Strenger V, Sovinz P, Lackner H, Schwinger W et al. Non-infectious causes of elevated procalcitonin and C-reactive protein serum levels in pediatric patients with hematologic and oncologic disorders. Support Care Cancer 2008;16:1035–1040 [CrossRef][PubMed]
    [Google Scholar]
  14. Fletcher R, Fletcher S, Fletcher G. Chapter 8, Diagnosis. In: Clinical Epidemiology: The Essentials, 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2014; pp.108–131
    [Google Scholar]
  15. Anand D, Das S, Bhargava S, Srivastava LM, Garg A et al. Procalcitonin as a rapid diagnostic biomarker to differentiate between culture-negative bacterial sepsis and systemic inflammatory response syndrome: a prospective, observational, cohort study. J Crit Care 2015;30:218.e7–218.e12 [CrossRef]
    [Google Scholar]
  16. Patil VK, Morjaria JB, De Villers F, Babu SK. Associations between procalcitonin and markers of bacterial Sepsis. Medicina 2012;48:383–387[PubMed]
    [Google Scholar]
  17. Hattori T, Nishiyama H, Kato H, Ikegami S, Nagayama M et al. Clinical value of procalcitonin for patients with suspected bloodstream infection. Am J Clin Pathol 2014;141:43–51 [CrossRef][PubMed]
    [Google Scholar]
  18. Miedema KG, de Bont ES, Elferink RF, van Vliet MJ, Nijhuis CS et al. The diagnostic value of CRP, IL-8, PCT, and sTREM-1 in the detection of bacterial infections in pediatric oncology patients with febrile neutropenia. Support Care Cancer 2011;19:1593–1600 [CrossRef][PubMed]
    [Google Scholar]
  19. Haeusler GM, Carlesse F, Phillips RS. An updated systematic review and meta-analysis of the predictive value of serum biomarkers in the assessment of fever during neutropenia in children with cancer. Pediatr Infect Dis J 2013;32:e390e396 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000478
Loading
/content/journal/jmm/10.1099/jmm.0.000478
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error