Serum Procalcitonin and Outcomes in Severe Pediatric Pneumonia: A Secondary Analysis of an Observational Multicenter Study.

Abstract

Background: Evidence on procalcitonin's (PCT) role in the management of severe pediatric pneumonia is limited. This study aims to determine the association between PCT and severity of illness in children with severe pneumonia.

Methods: In this secondary analysis of a multicenter study in Asia, peak serum PCT (measured within 5 days) was categorized into four groups (<0.5, 0.5-2.0, 2.0-10.0, and >10.0 ng/mL). The primary outcome was mortality and secondary outcomes were acute respiratory distress syndrome (ARDS), septic shock, and multiorgan dysfunction. Area under the receiver operating curve (AUROC) analysis was used to assess the association of peak PCT levels with primary and secondary outcomes.

Results: Of 846 patients, 344 had early PCT data. Mortality increased in groups with higher peak PCT levels [8/162 (4.9%), 3/69 (4.4%), 8/55 (14.6%) vs. 11/58 (19.0%); P = 0.002]. The proportion of patients with ARDS [23/162 (14.2%), 14/69 (20.3%), 10/55 (18.2%) vs. 25/58 (43.1%); P < 0.001], septic shock [8/162 (4.9%), 10/69 (14.5%), 13/55 (23.2%) vs. 32/58 (55.2%); P < 0.001], multiorgan failure [19/162 (11.7%), 13/69 (18.8%), 12/55 (21.4%) vs. 23/58 (39.7%); P < 0.001] was also higher in groups with higher peak PCT levels. AUROC for PCT showed moderate discrimination for mortality [0.69 (95%CI, 0.58, 0.80)] and good discrimination for septic shock [0.81 (95%CI, 0.76, 0.87)].

Conclusion: In critically ill children with severe pneumonia, higher serum PCT was associated with mortality, ARDS, septic shock, and multiorgan dysfunction. PCT alone is insufficient for clinical decision-making and should be interpreted alongside clinical assessment.