Procalcitonin Predicts Response to Beta-Lactam Treatment in Hospitalized Children with Community-Acquired Pneumonia
Procalcitonin Predicts Response to Beta-Lactam Treatment in Hospitalized Children with Community-Acquired Pneumonia
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DOI：
10.1371/journal.pone.0036927
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发表时间：
2012-05-17
期刊：
影响因子：
3.7
通讯作者：
Chalumeau, Martin
中科院分区：
文献类型：
--
作者：
Cohen, Jeremie F.;Leis, Alexander;Chalumeau, Martin
背景：儿童社区获得性肺炎(CAP)的抗生素治疗仍然主要是经验性的，因为临床和临床旁的发现很难区分社区获得性肺炎的主要原因。对β-内酰胺类药物的快速反应可被认为是肺炎球菌病原学的一个指标。我们的目标是确定CAP住院儿童对β-内酰胺类药物治疗反应的最佳生物学预测因子。方法：一项回顾性的单中心队列研究，包括2003-2010年间因CAP经验性单独使用β-内酰胺类药物治疗而在法国巴黎一家教学医院住院的所有1个月至16岁的患者。结果：在纳入的125例患者中，85%(106例)对β-内酰胺反应良好。在多因素Logistic回归分析中，我们发现降钙素原(PCT)是无热症的唯一独立预测因素(p=0.008)。PCT十进制对数的调整优势比为4.3(95%可信区间为1.5~12.7)。当PCT=3 ng/mL时，其敏感性为55.7%(45.7~65.3)，特异性为78.9%(54.4~93.9)，阳性预测值为93.7%(84.5~98.2)，阴性预测值为24.2%(14.2~36.7)，阳性似然比为2.64(1.09~6.42)，阴性似然比为0.56(0.41~0.77)。4例PCT水平<3 ng/m L且对β-内酰胺类药物治疗无反应的患儿中，3例继发胸腔积液，1例合并病毒感染。结论：PCT是CAP住院患儿对β-内酰胺类药物治疗反应良好的最佳独立生物学预测因子。因此，高PCT水平高度提示肺炎球菌病原学。然而，3 ng/毫升的临界值似乎不符合日常医疗实践，还需要进一步的研究来进一步确定PCT在管理儿童CAP中的作用。
Background: Antibiotic treatment of community-acquired pneumonia (CAP) in children remains mostly empirical because clinical and paraclinical findings poorly discriminate the principal causes of CAP. Fast response to beta-lactam treatment can be considered a proxy of pneumococcal aetiology. We aimed to identify the best biological predictor of response to beta-lactam therapy in children hospitalized for CAP.Methods: A retrospective, single-centre cohort study included all consecutive patients 1 month to 16 years old hospitalized in a teaching hospital in Paris, France, because of CAP empirically treated with a beta-lactam alone from 2003 to 2010. Uni-and multivariate analyses were used to study the ability of routine biological parameters available in the Emergency Department to predict a favourable response to beta-lactam (defined as apyrexia within 48 hours of treatment onset).Results: Among the 125 included patients, 85% (106) showed a favourable response to beta-lactam. In multivariate logistic regression, we found procalcitonin (PCT) the only independent predictor of apyrexia (p = 0.008). The adjusted odds ratio for the decadic logarithm of PCT was 4.3 (95% CI 1.5-12.7). At >= 3 ng/mL, PCT had 55.7% sensitivity (45.7-65.3), 78.9% specificity (54.4-93.9), 93.7% positive predictive value (84.5-98.2), 24.2% negative predictive value (14.2-36.7), 2.64 positive likelihood ratio (1.09-6.42) and 0.56 negative likelihood ratio (0.41-0.77). In the 4 children with a PCT level >= 3 ng/mL and who showed no response to beta-lactam treatment, secondary pleural effusion had developed in 3, and viral co-infection was documented in 1.Conclusions: PCT is the best independent biologic predictor of favourable response to beta-lactam therapy in children hospitalized for CAP. Thus, a high PCT level is highly suggestive of pneumococcal aetiology. However, a 3-ng/mL cut-off does not seem compatible with daily medical practice, and additional research is needed to further define the role of PCT in managing CAP in children.