Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Clinical Availability of Serum Procalcitonin in Children with Bacterical Infection

소아 세균감염증에서 혈청 procalcitonin의 임상적 유용성

  • Noe, Eun-Jung (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Lee, So-Yeon (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Lee, Kyu-Man (Department of Laboratory Medicine, College of Medicine, Hallym University) ;
  • Kim, Kwang-Nam (Department of Pediatrics, College of Medicine, Hallym University)
  • 노은정 (한림대학교 의과대학 소아과학교실) ;
  • 이소연 (한림대학교 의과대학 소아과학교실) ;
  • 이규만 (한림대학교 의과대학 진단검사의학교실) ;
  • 김광남 (한림대학교 의과대학 소아과학교실)
  • Received : 2010.08.26
  • Accepted : 2010.10.17
  • Published : 2010.12.25
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Abstract

Purpose : The aim of this study was to identify clinical availability of serum procalcitonin (PCT) compared with C-reactive protein (CRP) in prediction of bacterial infection in children. Methods : A retrospective study was conducted with children who had been admitted to the Department of Pediatrics with bacterial and viral infection between April 2008 and March 2009 and children who were admitted with Juvenile rheumatoid arthritis (JRA) between August 2007 and July 2009. Serum PCT levels were measured using an enzyme-linked fluorescent assay. Results : The study population included 10 patients with bacterial infection (group I), 69 with viral infection (group II), and 35 with JRA (group III). Mean PCT levels were significantly higher in group I than in group II or group III (P<0.05). Mean CRP levels were significantly higher in group I than in group II (P<0.05); however, mean CRP levels were not significantly higher in group I than in group III (P>0.05). Using a cutoff of 0.5 ng/mL for PCT and 8 mg/L for CRP, sensitivity and specificity in distinguishing between group I and the other groups were 60.0% and 92.3% for PCT and 60.0% and 40.1% for CRP, respectively. Positive and negative predictive values were 42.9% and 96.0% for PCT and 10.0% and 92.6% for CRP, respectively. Conclusion : Measurement of PCT concentrations appears to be more useful than CRP for distinguishing between bacterial infection and non-bacterial diseases in children.

목적: 소아 세균감염증에서 혈청 PCT 수치의 유용성를 알아보기 위하여 세균감염증 환자들의 PCT 수치와 바이러스 감염증 및 비감염성 염증질환인 Juvenile rhematoid arthritis (JRA) 환자들의 PCT 수치를 비교하였다. 또한 PCT 검사의 유용성을 CRP 검사와 비교하여 평가하였다. 방법: 2008년 4월부터 2009년 3월 사이에 소아청소년과에 입원치료 한 환자들 중 세균 감염이 확인된 10명, 바이러스 감염이 확인된 69명과 2007년 8월부터 2009년 7월 사이에 JRA로 입원한 35명의 환아들을 대상으로 후향적으로 조사하였다. 대상 환아들의 PCT와 CRP 수치를 분석하였고, 증상에 따라 추가되었던 배양검사와 바이러스검사 결과들로부터 환자들을 크게 세군감염군(I군)과 바이러스 감염군(II군), 비감염성 염증질환군(III군)으로 분류하여 각 군간의 PCT, CRP 수치를 비교하여 통계적 유의성을 평가하였다. 결과: I, II, III군의 CRP 평균값은 각각 62.07${\pm}$28.97 mg/L, 30.35${\pm}$15.49 mg/L, 17.95${\pm}$11.03 mg/L였고, PCT 평균값은 각각 5.56${\pm}$1.99 ng/mL, 0.24${\pm}$0.76 ng/mL, 0.06${\pm}$1.06 ng/mL로 CRP와 PCT 모두 세 군 사이에 통계적으로 유의한 차이를 보였다(P<0.05). 두 군간의 CRP를 비교하였을 때, I군과 II군 사이에는 통계적으로 유의한 차이를 보였으나(P=0.0057) I과 III, II과 III 사이에서는 유의한 차이를 보이지 않았다(P>0.05). 반면 두 군간의 PCT를 비교하였을 때 I군과 II, I군과 III군 모두 통계적으로 유의한 차이를 보였다(P<0.0001). PCT (Cutoff value=0.5 ng/mL)의 민감도와 특이도, 양성예측도와 음성예측도는 각각 60.0%, 92.3%, 42.9%, 96.0%였으며, CRP (Cutoff value=8 mg/L)의 민감도, 특이도, 양성예측도, 음성예측도는 각각 60.0%, 40.1%, 10.0%. 92.6%였다. 결론: 소아 세균감염 환자에서의 PCT검사는 비세균성 질환과 감별에 있어 CRP에 비해 유용한 검사라 할 수 있을 것이다.

Keywords

References

  1. Jacobs JW, Lund PK, Potts Jr JT, Bell NH, Habener JF. Procalcitonin is a glycoprotein. J Biol Chem 1981; 256:2803-7.
  2. Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med 2000;26:1193-200. https://doi.org/10.1007/s001340000624
  3. Gendrel D, Bohuon C. Procalcitonin as a maker of bacterial infection. Pediatr Infect Dis J 2000;19:679-87. https://doi.org/10.1097/00006454-200008000-00001
  4. Meisner M, Schmidt J, Huttner H, Tschaikowsky K. The natural elimination rate of procalcitonin in patients with normal and impaired renal function. Intensive Care Med 2000;26:S212-6. https://doi.org/10.1007/BF02900740
  5. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341: 515-8. https://doi.org/10.1016/0140-6736(93)90277-N
  6. Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med 2003; 31:1737-41. https://doi.org/10.1097/01.CCM.0000063440.19188.ED
  7. Mitaka C. Clinical laboratory differentiation of infectious versus non-infectious systemic inflammatory response syndrome. Clinica Chimica Acta 2005;351:17-29. https://doi.org/10.1016/j.cccn.2004.08.018
  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;39:206-17. https://doi.org/10.1086/421997
  9. Kim EK, Lee BS, Lee JA, Jo HS, Park JD, Kim BI, Choi JH. Clinical Availability of Serum Procalcitonin Level in the Diagnosis of Neonatal Bacterial Infection. J Korean Soc Neonatol 2001;8:211-21.
  10. Kim DW, Chung JY, Koo JW, Kim SW, Han TH. Usefulness of serum procalcitonin test for the diagnosis of upper urinary tract infection in children. Korean J Pediatr 2006; 49:87-92. https://doi.org/10.3345/kjp.2006.49.1.87
  11. Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents 2002;20:1-9.
  12. Hoffmann G, Czechowski M, Schloesser M, Schobersberger W. Procalcitonin amplifies inducible nitric oxide synthase gene expression and nitric oxide production in vascular smooth muscle cells. Crit Care Med 2002;30: 2091-5. https://doi.org/10.1097/00003246-200209000-00023
  13. Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164:396-402. https://doi.org/10.1164/ajrccm.164.3.2009052
  14. Hatherill M, Tibby SM, Sykes K, Turner C, Murdoch IA. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child 1999;81:417-21. https://doi.org/10.1136/adc.81.5.417
  15. Eberhard OK, Haubitz M, Brunkhorst FM, Kliem V, Koch KM, Brunkhorst R. Usefulness of procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheum 1997;40:1250-6. https://doi.org/10.1002/1529-0131(199707)40:7<1250::AID-ART9>3.0.CO;2-A
  16. Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J 2007;26:672-7. https://doi.org/10.1097/INF.0b013e31806215e3
  17. Suprin E, Camus C, Gacouin A, Le Tulzo Y, Feuillu A, Thomas R. Procalcitonin: a valuable indicator of infection in a medical ICU? Intensive Care Med 2000;26: 1232-8. https://doi.org/10.1007/s001340000580