Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil.
Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil.
Clin Chim Acta. 2019 Feb;489:212-218. doi: 10.1016/j.cca.2017.12.021. Epub 2017 Dec 16.
Childhood community-acquired pneumonia is a common and potentially life-threatening illness in developing countries. We assessed the prognostic value of serum procalcitonin level upon admission on clinical response to antibiotic treatment.
Out of 89 patients, the median (IQR) age was 19(12-29) months and 60% were boys. Viral (49.5%), typical bacterial (38%) and atypical bacterial (12.5%) infections as well as probable pneumococcal infections (26%) were diagnosed.
Seventy-five (84%) children became afebrile ≤48h after treatment. In 14 children who remained febrile after 48h of treatment, median[IQR] serum procalcitonin (ng/ml) level on admission was higher than in those with rapid recovery (2.1[0.8-3.7] vs 0.6[0.1-2.2]; P=0.025). In the slow-responding children, pneumococcal infections were more common (71% vs 17%; P<0.001). Procalcitonin concentrations on admission were higher in children with pneumococcal pneumonia compared to children with non-pneumococcal pneumonia (2[0.7-4.2] vs 0.5[0.08-2.1]; P=0.002). The ROC curve found that <0.25ng/ml of serum procalcitonin had a high negative predictive value (93%[95%CI:80%-99%]) for pneumococcal infection. All children that remained febrile after 48h of treatment had procalcitonin >0.25ng/ml on admission. The majority of children with pneumonia in a developing country become afebrile within 48h after onset of antibiotic treatment.
Serum procalcitonin <0.25ng/ml predicted rapid clinical response and non-pneumococcal etiology.
儿童社区获得性肺炎在发展中国家是一种常见且潜在危及生命的疾病。我们评估了入院时降钙素原水平对临床抗生素治疗反应的预后价值。
在 89 例患者中，中位（IQR）年龄为 19（12-29）个月，60%为男孩。诊断为病毒（49.5%）、典型细菌（38%）和非典型细菌（12.5%）感染以及可能的肺炎球菌感染（26%）。
75（84%）例患儿在治疗后 48 小时内退热。在 14 例治疗 48 小时后仍发热的患儿中，入院时的中位（IQR）降钙素原（ng/ml）水平高于快速恢复的患儿（2.1[0.8-3.7] vs 0.6[0.1-2.2]；P=0.025）。在反应较慢的患儿中，更常见的是肺炎球菌感染（71% vs 17%；P<0.001）。与非肺炎球菌肺炎患儿相比，肺炎球菌肺炎患儿的降钙素原浓度入院时更高（2[0.7-4.2] vs 0.5[0.08-2.1]；P=0.002）。ROC 曲线发现，血清降钙素原<0.25ng/ml 对肺炎球菌感染具有较高的阴性预测值（93%[95%CI：80%-99%]）。所有治疗 48 小时后仍发热的患儿入院时的降钙素原均>0.25ng/ml。发展中国家大多数肺炎患儿在抗生素治疗开始后 48 小时内退热。
血清降钙素原<0.25ng/ml 预测快速临床反应和非肺炎球菌病因。
