Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;145(6):e20193728.
doi: 10.1542/peds.2019-3728. Epub 2020 May 13.

Biomarkers and Disease Severity in Children With Community-Acquired Pneumonia

Todd A Florin  1 , Lilliam Ambroggio  2 , Cole Brokamp  3   4 , Yin Zhang  3   4 , Mantosh Rattan  5   6 , Eric Crotty  5   6 , Michael A Belsky  7 , Sara Krueger  6 , Thomas N Epperson 4th  8 , Andrea Kachelmeyer  4   9 , Richard Ruddy  4   9 , Samir S Shah  4   10
Affiliations

Biomarkers and Disease Severity in Children With Community-Acquired Pneumonia

Todd A Florin et al. Pediatrics. 2020 Jun.

Erratum in

Abstract

Background: Host biomarkers predict disease severity in adults with community-acquired pneumonia (CAP). We evaluated the association of the white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), and procalcitonin with the development of severe outcomes in children with CAP.

Methods: We performed a prospective cohort study of children 3 months to 18 years of age with CAP in the emergency department. The primary outcome was disease severity: mild (discharged from the hospital), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (eg, hospitalized with receipt of intravenous fluids, supplemental oxygen, complicated pneumonia), and severe (eg, intensive care, vasoactive infusions, chest drainage, severe sepsis). Outcomes were examined within the cohort with suspected CAP and in a subset with radiographic CAP.

Results: Of 477 children, there were no statistical differences in the median WBC count, ANC, CRP, or procalcitonin across severity categories. No biomarker had adequate discriminatory ability between severe and nonsevere disease (area under the curve [AUC]: 0.53-0.6 for suspected CAP and 0.59-0.64 for radiographic CAP). In analyses adjusted for age, antibiotic use, fever duration, and viral pathogen detection, CRP was associated with moderate-severe disease (odds ratio 1.12; 95% confidence interval, 1.0-1.25). CRP and procalcitonin revealed good discrimination of children with empyema requiring chest drainage (AUC: 0.83) and sepsis with vasoactive infusions (CRP AUC: 0.74; procalcitonin AUC: 0.78), although prevalence of these outcomes was low.

Conclusions: WBC count, ANC, CRP, and procalcitonin are generally not useful to discriminate nonsevere from severe disease in children with CAP, although CRP and procalcitonin may have some utility in predicting the most severe outcomes.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Study flow diagram.
FIGURE 2
FIGURE 2
Blood biomarkers and disease severity. The median biomarker concentration is represented by the middle line in each box. The lower and upper boarders of the box represent the 25th and 75th percentiles, respectively. A, WBC count (P = .24). B, ANC (P = .26). C, CRP (P = .6). D, Procalcitonin (P = .21).
See this image and copyright information in PMC

References

    1. Keren R, Luan X, Localio R, et al. ; Pediatric Research in Inpatient Settings (PRIS) Network . Prioritization of comparative effectiveness research topics in hospital pediatrics. Arch Pediatr Adolesc Med. 2012;166(12):1155–1164 - PubMed
    1. Florin TA, French B, Zorc JJ, Alpern ER, Shah SS. Variation in emergency department diagnostic testing and disposition outcomes in pneumonia. Pediatrics. 2013;132(2):237–244 - PubMed
    1. Williams DJ, Zhu Y, Grijalva CG, et al. . Predicting severe pneumonia outcomes in children. Pediatrics. 2016;138(4):e20161019. - PMC - PubMed
    1. Luna CM. C-reactive protein in pneumonia: let me try again. Chest. 2004;125(4):1192–1195 - PubMed
    1. Becker KL, Nylén ES, White JC, Müller B, Snider RH Jr.. Clinical review 167: procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004;89(4):1512–1525 - PubMed

Publication types