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

TITLE=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

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 9 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.684628

DOI=10.3389/fped.2021.684628

ISSN=2296-2360

ABSTRACT=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/mm3 vs. 9,251/mm3, 223 mg/L vs. 72 mg/L and 8.6 ng/mL 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.