Serum procalcitonin as an early inflammatory marker in pediatric ventilator-associated pneumonia: A prospective observational study

Abstract

Background: Delayed diagnosis of ventilator-associated pneumonia (VAP) in pediatric patients is associated with accentuated risk of morbidities and mortality. Early diagnosis of VAP is challenging. Serum procalcitonin has been proposed as a promising inflammatory marker for the early diagnosis of VAP, but there is a lack of sufficient evidence for the use of serum procalcitonin for early diagnosis of VAP in children. The present study was conducted to determine the role of serum procalcitonin as an early inflammatory marker for an early and provisional diagnosis of VAP among clinically suspected VAP patients in pediatric intensive care unit settings. Subjects and Methods: Seventy-nine pediatric patients (age: 1 month–18 years) with suspected VAP (Simplified Clinical Pulmonary Infection Score >6) were prospectively evaluated with quantitative bronchoalveolar lavage cultures and simultaneously tested for serum procalcitonin levels. Two groups were identified based on culture results and comparatively evaluated for procalcitonin levels, its diagnostic efficacy, antibiotic usage patterns, and mechanical ventilation duration. Results: The VAP group had 39 patients, and the non-VAP group had 40 patients. Thirty-two (82%) patients in the VAP group had a procalcitonin value ≥10 ng/ml as against 10 (25%) from the non-VAP group. Two (5.1%) patients in the VAP group had procalcitonin levels ≤1 ng/ml as against 21 (52.5%) patients in the non-VAP group. The receiver operating characteristic area under curve for procalcitonin with a cutoff >10 ng/ml was 0.785 (95% confidence interval = 0.678–0.870) with a sensitivity of 82.05% and specificity of 75%. Conclusions: Serum procalcitonin is a reliable biomarker to augment the provisional diagnosis of VAP in clinically suspected cases. Such diagnosis may help in an early institution of definitive therapy for VAP.