PLoS ONE (Jan 2021)

Procalcitonin, C-reactive protein, neutrophil gelatinase-associated lipocalin, resistin and the APTT waveform for the early diagnosis of serious bacterial infection and prediction of outcome in critically ill children.

  • Maryke J Nielsen,
  • Paul Baines,
  • Rebecca Jennings,
  • Sarah Siner,
  • Ruwanthi Kolamunnage-Dona,
  • Paul Newland,
  • Matthew Peak,
  • Christine Chesters,
  • Graham Jeffers,
  • Colin Downey,
  • Caroline Broughton,
  • Lynsey McColl,
  • Jennifer Preston,
  • Anthony McKeever,
  • Stephane Paulus,
  • Nigel Cunliffe,
  • Enitan D Carrol

DOI
https://doi.org/10.1371/journal.pone.0246027
Journal volume & issue
Vol. 16, no. 2
p. e0246027

Abstract

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ObjectiveBacterial Infections remains a leading cause of death in the Paediatric Intensive Care Unit (PICU). In this era of rising antimicrobial resistance, new tools are needed to guide antimicrobial use. The aim of this study was to investigate the accuracy of procalcitonin (PCT), neutrophil gelatinase-associated lipocalin (NGAL), resistin, activated partial thromboplastin time (aPTT) waveform and C-reactive protein (CRP) for the diagnosis of serious bacterial infection (SBI) in children on admission to PICU and their use as prognostic indicators.SettingA regional PICU in the United Kingdom.PatientsConsecutive PICU admissions between October 2010 and June 2012.MeasurementsBlood samples were collected daily for biomarker measurement. The primary outcome measure was performance of study biomarkers for diagnosis of SBI on admission to PICU based on clinical, radiological and microbiological criteria. Secondary outcomes included durations of PICU stay and invasive ventilation and 28-day mortality. Patients were followed up to day 28 post-admission.Main resultsA total of 657 patients were included in the study. 92 patients (14%) fulfilled criteria for SBI. 28-day mortality was 2.6% (17/657), but 8.7% (8/92) for patients with SBI. The combination of PCT, resistin, plasma NGAL and CRP resulted in the greatest net reclassification improvement compared to CRP alone (0.69, pConclusionCombinations of biomarkers, including PCT, may improve accurate and timely identification of SBI on admission to PICU.