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      Serum Procalcitonin Levels in Children with Clinical Syndromes for Targeting Antibiotic Use at an Emergency Department of a Kenyan Hospital

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      Author(s): , MMED, PhD 1 , 2 , , , MMED 1 , , MMED, MSC 1
      Publication date PMC-release:
      Journal: Journal of tropical pediatrics
      Keywords: pneumonia, sepsis, procalcitonin, children, WHO, Africa

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          Abstract

          Serum procalcitonin (PCT) was measured in 228 children aged 1 month to 15 years at an emergency department of a hospital located in an area without local malaria transmission in children with suspected infections; 21% (49) children had a clinical syndrome for suspected bacterial infections (Syndrome +ve). In children with Syndrome +ve criteria, 27/49 (55.1%) had PCT ≥ 0.5 μg/l but only 59/179 (32.9%) of those Syndrome +ve had abnormal PCT, χ 2 = 8.0, p = 0.005; positive likelihood ratio = 2.0 [95% confidence interval (CI) 1.2–3.3]; negative likelihood ratio = 0.8 (95% CI 0.7–1.0). In patients with pneumonia, 9/15 (60%) with severe pneumonia had PCT ≥ 0.5 μg/l compared to 11/21 (52.4%) with non-severe pneumonia, χ 2 = 0.2, p = 0.65. Children with clinical signs of pneumonia or clinical signs suggestive of bacterial infections fulfilling clinical syndromic definitions for suspected bacterial infections commonly have elevated PCT level. PCT levels are associated with disease severity and antibiotic trials guided by PCT levels may be needed where cultures are not available.

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          Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis.

          Li Liu, Shefali Oza, Daniel B. Hogan … (2015)
          Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000-13, and cause-specific mortality scenarios to 2030 and 2035. We estimated the distributions of causes of child mortality separately for neonates and children aged 1-59 months. To generate cause-specific mortality fractions, we included new vital registration and verbal autopsy data. We used vital registration data in countries with adequate registration systems. We applied vital registration-based multicause models for countries with low under-5 mortality but inadequate vital registration, and updated verbal autopsy-based multicause models for high mortality countries. We used updated numbers of child deaths to derive numbers of deaths by causes. We applied two scenarios to derive cause-specific mortality in 2030 and 2035. Of the 6·3 million children who died before age 5 years in 2013, 51·8% (3·257 million) died of infectious causes and 44% (2·761 million) died in the neonatal period. The three leading causes are preterm birth complications (0·965 million [15·4%, uncertainty range (UR) 9·8-24·5]; UR 0·615-1·537 million), pneumonia (0·935 million [14·9%, 13·0-16·8]; 0·817-1·057 million), and intrapartum-related complications (0·662 million [10·5%, 6·7-16·8]; 0·421-1·054 million). Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3·6 million fewer deaths recorded in 2013 versus 2000. Causes with the slowest progress were congenital, preterm, neonatal sepsis, injury, and other causes. If present trends continue, 4·4 million children younger than 5 years will still die in 2030. Furthermore, sub-Saharan Africa will have 33% of the births and 60% of the deaths in 2030, compared with 25% and 50% in 2013, respectively. Our projection results provide concrete examples of how the distribution of child causes of deaths could look in 15-20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child. Bill & Melinda Gates Foundation. Copyright © 2015 Elsevier Ltd. All rights reserved.
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            International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics.

            Brahm Goldstein, Brett Giroir, Adrienne G Randolph (2005)
            Although general definitions of the sepsis continuum have been published for adults, no such work has been done for the pediatric population. Physiologic and laboratory variables used to define the systemic inflammatory response syndrome (SIRS) and organ dysfunction require modification for the developmental stages of children. An international panel of 20 experts in sepsis and clinical research from five countries (Canada, France, Netherlands, United Kingdom, and United States) was convened to modify the published adult consensus definitions of infection, sepsis, severe sepsis, septic shock, and organ dysfunction for children. Consensus conference. This document describes the issues surrounding consensus on four major questions addressed at the meeting: a) How should the pediatric age groups affected by sepsis be delineated? b) What are the specific definitions of pediatric SIRS, infection, sepsis, severe sepsis, and septic shock? c) What are the specific definitions of pediatric organ failure and the validity of pediatric organ failure scores? d) What are the appropriate study populations and study end points required to successfully conduct clinical trials in pediatric sepsis? Five subgroups first met separately and then together to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiological data, and coagulation variables. All conference participants approved the final draft of the proceedings of the meeting. Conference attendees modified the current criteria used to define SIRS and sepsis in adults to incorporate pediatric physiologic variables appropriate for the following subcategories of children: newborn, neonate, infant, child, and adolescent. In addition, the SIRS definition was modified so that either criteria for fever or white blood count had to be met. We also defined various organ dysfunction categories, severe sepsis, and septic shock specifically for children. Although no firm conclusion was made regarding a single appropriate study end point, a novel nonmortality end point, organ failure-free days, was considered optimal for pediatric clinical trials given the relatively low incidence of mortality in pediatric sepsis compared with adult populations. We modified the adult SIRS criteria for children. In addition, we revised definitions of severe sepsis and septic shock for the pediatric population. Our goal is for these first-generation pediatric definitions and criteria to facilitate the performance of successful clinical studies in children with sepsis.
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              Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis.

              Benjamin Tang, Guy D Eslick, Jonathan Craig … (2007)
              Procalcitonin is widely reported as a useful biochemical marker to differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome. In this systematic review, we estimated the diagnostic accuracy of procalcitonin in sepsis diagnosis in critically ill patients. 18 studies were included in the review. Overall, the diagnostic performance of procalcitonin was low, with mean values of both sensitivity and specificity being 71% (95% CI 67-76) and an area under the summary receiver operator characteristic curve of 0.78 (95% CI 0.73-0.83). Studies were grouped into phase 2 studies (n=14) and phase 3 studies (n=4) by use of Sackett and Haynes' classification. Phase 2 studies had a low pooled diagnostic odds ratio of 7.79 (95% CI 5.86-10.35). Phase 3 studies showed significant heterogeneity because of variability in sample size (meta-regression coefficient -0.592, p=0.017), with diagnostic performance upwardly biased in smaller studies, but moving towards a null effect in larger studies. Procalcitonin cannot reliably differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome in critically ill adult patients. The findings from this study do not lend support to the widespread use of the procalcitonin test in critical care settings.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 8010948
                Journal ID (nlm-ta): J Trop Pediatr
                Journal ID (iso-abbrev): J Trop Pediatr
                Title: Journal of tropical pediatrics
                ISSN (Print): 0142-6338
                ISSN (Electronic): 1465-3664
                Publication date Nihms-submitted: 09 November 2020
                Publication date (Print): 01 February 2020
                Publication date PMC-release: 24 November 2020
                Volume: 66
                Issue: 1
                Pages: 29-37
                Affiliations
                Department of Paediatrics and Child Health, Aga Khan University of Nairobi, P.O. Box 30270-00100, Nairobi, Kenya
                Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
                Author notes
                Correspondence: Samuel O. Akech, Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, 197 Lenana Place, Lenana Road, Kenya. < sakech@ 123456kemri-wellcome.org >.
                Author information
                http://orcid.org/0000-0001-5126-1225
                Article
                Manuscript ID: EMS103735
                DOI: 10.1093/tropej/fmz027
                PMC ID: 7116410
                PubMed ID: 31062031
                SO-VID: 5d36d6e1-3b5d-4802-9394-87615e3b3a7a
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Subject: Article

                ScienceOpen disciplines: Pediatrics
                Keywords: pneumonia,sepsis,procalcitonin,children,who,africa
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: pneumonia, sepsis, procalcitonin, children, who, africa

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