Frontiers in Pediatrics (Oct 2021)

Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018

  • Danaé Dudognon,
  • Corinne Levy,
  • Corinne Levy,
  • Corinne Levy,
  • Corinne Levy,
  • Martin Chalumeau,
  • Martin Chalumeau,
  • Sandra Biscardi,
  • Sandra Biscardi,
  • Marie-Aliette Dommergues,
  • Marie-Aliette Dommergues,
  • François Dubos,
  • François Dubos,
  • Karine Levieux,
  • Karine Levieux,
  • Marie Aurel,
  • Marie Aurel,
  • Philippe Minodier,
  • Philippe Minodier,
  • Ferielle Zenkhri,
  • Ferielle Zenkhri,
  • Ellia Mezgueldi,
  • Ellia Mezgueldi,
  • Irina Craiu,
  • Irina Craiu,
  • Laurence Morin,
  • Laurence Morin,
  • Stéphane Béchet,
  • Emmanuelle Varon,
  • Robert Cohen,
  • Robert Cohen,
  • Robert Cohen,
  • Robert Cohen,
  • Robert Cohen,
  • Jérémie F. Cohen,
  • Jérémie F. Cohen,
  • The Pneumonia Study Group,
  • François Angoulvant,
  • Yves Gillet,
  • Christèle Gras-Le Guen,
  • Isabelle Hau,
  • Laure Hees,
  • Elise Launay,
  • Mathie Lorrot,
  • Fouad Madhi,
  • Alain Martinot,
  • Naim Ouldali

DOI
https://doi.org/10.3389/fped.2021.684628
Journal volume & issue
Vol. 9

Abstract

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Objective(s): Blood cultures (BC), when performed in children seen in the emergency department with community-acquired pneumonia (CAP), are most of the time sterile. We described the diagnostic accuracy of white blood cells (WBC), absolute neutrophils count (ANC), C-reactive protein (CRP), and procalcitonin (PCT) to predict blood culture (BC) result in childhood CAP.Study Design: Secondary analysis of a prospective study carried out in eight pediatric emergency departments (France, 2009–2018), including children (≤15 years) with CAP. Analyses involved univariate comparisons and ROC curves.Results: We included 13,752 children with CAP. BC was positive in 137 (3.6%) of the 3,829 children (mean age 3.7 years) in whom it was performed, mostly with Streptococcus pneumoniae (n = 107). In children with bacteremia, ANC, CRP and PCT levels were higher (median 12,256 vs. 9,251/mm3, 223 vs. 72 mg/L and 8.6 vs. 1.0 ng/mL, respectively; p ≤ 0.002), but WBC levels were not. The area under the ROC curve of PCT (0.73 [95%CI 0.64–0.82]) was significantly higher (p ≤ 0.01) than that of WBC (0.51 [0.43–0.60]) and of ANC (0.55 [0.46–0.64]), but not than that of CRP (0.66 [0.56–0.76]; p = 0.21). CRP and PCT thresholds that provided a sensitivity of at least 90% were 30 mg/L and 0.25 ng/mL, respectively, for a specificity of 25.4 and 23.4%, respectively. CRP and PCT thresholds that provided a specificity of at least 90% were 300 mg/L and 20 ng/mL, respectively, for a sensitivity of 31.3 and 28.9%, respectively.Conclusions: PCT and CRP are the best routinely available predictive biomarkers of bacteremia in childhood CAP.

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