Vanderbilt University Medical Center, Nashville, Tennessee;
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Hosp Pediatr. 2021 Mar;11(3):215-222. doi: 10.1542/hpeds.2020-001842. Epub 2021 Feb 12.
To determine if serum procalcitonin, an indicator of bacterial etiology in pneumonia in all ages and a predictor of severe pneumonia in adults, is associated with disease severity in children with community-acquired pneumonia.
We prospectively enrolled children 2 months to <18 years with clinical and radiographic pneumonia at 2 children's hospitals (2014-2019). Procalcitonin samples were obtained at presentation. An ordinal outcome scale of pneumonia severity was defined: very severe (intubation, shock, or death), severe (intensive care admission without very severe features and/or high-flow nasal cannula), moderate (hospitalization without severe or very severe features), and mild (discharge). Hospital length of stay (LOS) was also examined. Ordinal logistic regression was used to model associations between procalcitonin and outcomes. We estimated adjusted odds ratios (aORs) for a variety of cut points of procalcitonin ranging from 0.25 to 3.5 ng/mL.
The study included 488 children with pneumonia; 30 (6%) were classified as very severe, 106 (22%) as severe, 327 (67%) as moderate, and 25 (5%) as mild. Median procalcitonin in the very severe group was 5.06 (interquartile range [IQR] 0.90-16.83), 0.38 (IQR 0.11-2.11) in the severe group, 0.29 (IQR 0.09-1.90) in the moderate group, and 0.21 (IQR 0.12-1.2) in the mild group. Increasing procalcitonin was associated with increasing severity (range of aORs: 1.03-1.25) and increased LOS (range of aORs: 1.04-1.36). All comparisons were statistically significant.
Higher procalcitonin was associated with increased severity and LOS. Procalcitonin may be useful in helping clinicians evaluate pneumonia severity.
确定血清降钙素原（一种各年龄段肺炎细菌病因的指标，也是成人重症肺炎的预测指标）是否与社区获得性肺炎患儿的疾病严重程度相关。
我们前瞻性地招募了 2 家儿童医院（2014-2019 年）的 2 个月至<18 岁的具有临床和影像学肺炎的儿童。在就诊时采集降钙素原样本。定义肺炎严重程度的等级量表：非常严重（插管、休克或死亡）、严重（无非常严重特征和/或高流量鼻导管的重症监护入院）、中度（无严重或非常严重特征的住院）和轻度（出院）。还检查了住院时间（LOS）。使用有序逻辑回归来模拟降钙素原与结局之间的关联。我们估计了降钙素原各种截断值（0.25 至 3.5ng/mL）与结局之间的调整优势比（aOR）。
该研究纳入了 488 例肺炎患儿；30 例（6%）被归类为非常严重，106 例（22%）为严重，327 例（67%）为中度，25 例（5%）为轻度。非常严重组的中位降钙素原为 5.06（四分位距 [IQR] 0.90-16.83），严重组为 0.38（IQR 0.11-2.11），中度组为 0.29（IQR 0.09-1.90），轻度组为 0.21（IQR 0.12-1.2）。降钙素原升高与严重程度增加相关（aOR 范围：1.03-1.25）和 LOS 增加（aOR 范围：1.04-1.36）。所有比较均具有统计学意义。
较高的降钙素原与严重程度和 LOS 增加相关。降钙素原可能有助于临床医生评估肺炎的严重程度。
