Combination of procalcitonin and C-reactive protein levels in the early diagnosis of bacterial co-infections in children with H1N1 influenza

Abstract

Objective: This study evaluated the diagnostic value of measuring the levels of procalcitonin (PCT) and C-reactive protein (CRP) to differentiate children co-infected with H1N1 influenza and bacteria from children infected with H1N1 influenza alone.

Methods: Consecutive patients (children aged < 5 years) with laboratory-confirmed H1N1 influenza who were hospitalized or received outpatient care from a tertiary-care hospital in Canton, China, between January 1, 2012, and September 1, 2017, were included in the present study. Laboratory results, including serum PCT and CRP levels, white blood cell (WBC) counts, and bacterial cultures, were analyzed. The predictive value of the combination of biomarkers versus any of the biomarkers alone for diagnosing bacterial co-infections was evaluated using logistic regression analyses.

Results: Significantly higher PCT (1.46 vs 0.21 ng/mL, P < 0.001) and CRP (19.20 vs 5.10 mg/dL, P < 0.001) levels were detected in the bacterial co-infection group than in the H1N1 infection-alone group. Using PCT or CRP levels alone, the areas under the curves (AUCs) for predicting bacterial co-infections were 0.801 (95% CI, 0.772-0.855) and 0.762 (95% CI, 0.722-0.803), respectively. Using a combination of PCT and CRP, the logistic regression-based model, Logit(P) = -1.912 + 0.546 PCT + 0.087 CRP, showed significantly greater accuracy (AUC: 0.893, 95% CI: 0.842-0.934) than did the other three biomarkers.

Conclusions: The combination of PCT and CRP levels could provide a useful method of distinguishing bacterial co-infections from an H1N1 influenza infection alone in children during the early disease phase. After further validation, the flexible model derived here could assist clinicians in decision-making processes.

Keywords: C-reactive protein; H1N1 influenza; bacterial co-infection; procalcitonin.

Figure 1

Serum PCT (A), CRP (B), and WBC (C) levels in patients with H1N1 influenza who presented with and without bacterial co‐infections. The differences between the H1N1‐alone group and bacterial co‐infection group were examined using the Wilcoxon rank‐sum test

Figure 2

ROC curves of PCT, CRP, WBC, and PCT&CRP (Logit(P) = −1.912 + 0.546 PCT + 0.087 CRP) for differentiating patients with bacterial co‐infections from those infected with H1N1 alone