Información de la revista
Vol. 55. Núm. 4.
Páginas 321-328 (octubre 2001)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 55. Núm. 4.
Páginas 321-328 (octubre 2001)
Acceso a texto completo
Procalcitonina para el diagnóstico precoz de infección bacteriana invasiva en el lactante febril
Use of procalcitonin in a pediatric emergency department in the early detection of invasive bacterial infectionin in fants
Visitas
14376
A. Fernández Lópeza,
Autor para correspondencia
30775alf@comb.es

Correspondencia: Servicio de Pediatría. Hospital Sant Joan de Déu. P.° Sant Joan de Déu, 2. 08950 Esplugues de Llobregat. Barcelona.
, C. Luaces Cubellsa, C. Valls Tolosab, J. Ortega Rodrígueza, J.J. García Garcíaa, A. Mira Valletc, J. Pou Fernándeza
a Sección de Urgencias Pediátricas. Servicio de Pediatría. Unidad Integrada Hospital Sant Joan de Déu-Clínic
b Servicios de Bioquímica. Hospital Universitario Sant Joan de Déu. Universidad de Barcelona
c Servicios de Coordinación de Servicios Diagnósticos. Hospital Universitario Sant Joan de Déu. Universidad de Barcelona
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Antecedentes

La procalcitonina es un parámetro nuevo de infección bacteriana. Por su vida media más corta y ascenso másprecoz puede ofrecer ventajas respecto a la proteína C re-activa (PCR).

Objetivo

Evaluar la rentabilidad diagnóstica de la procalcitonina en la detección precoz de infección bacteriana invasiva en el lactante febril frente a la PCR.

Material y método

Estudio prospectivo y observacional realizado en la sec-ción de urgencias entre enero de 1998 y febrero de2000 que incluyó lactantes entre 1 y 36 meses, atendidospor fiebre, en los que debieron practicarse determinacio-nes analíticas sanguíneas. Se evaluaron los valores plas-máticos de procalcitonina y PCR y se correlacionan con el diagnóstico final. Se elaboran las curvas ROC (receiva ope-rating characteristic) para ambos marcadores.

Resultados

Se incluyeron en el estudio 100 lactantes con edad media de 8,8 meses (DE, 7,59) distribuidos en 4 grupos de 25 pacientes (infección viral, bacteriana localizada, bacteriana invasiva y grupo control). Los valores medios de procalcitonina y PCR en infecciones invasivas (procalcitonina, 14,45 ng/ml [DE, 27,95]; PCR, 95,10 mg/l [DE, 33,04]) fueron significativamente superiores a las no invasivas (procalcitonina, 0,27 ng/ml [DE, 0,19]; PCR, 25,67 mg/l [DE, 33,04]) pero la rentabilidad diagnóstica de procalcitonina fue mayor. El área bajo la curva para procalcitonina fue de 0,95 (DE, 0,03), superior a la obtenida para PCR (0,81 [DE, 0,05]) (p < 0,001). El cut-off óptimo para procalcitonina se sitúa en > 0,4 ng/ml (sensibilidad 95,5 %, especificidad 86,4 %) y para PCR en > 42,9 mg/l con sensibilidad 75 % y especificidad 81,8 %. En los lactantes con fiebre inferior a 12 h (n = 30), el área bajo la curva para procalcitonina ha sido 0,90 (DE, 0,06), también superior a la PCR (0,64 [DE, 0,11]) (p < 0,001). El cut-off óptimo para procalcitonina en este grupo es > 0,4 ng/ml (sensibilidad, 90 %; especificidad, 94 %) y para PCR es > 26,6 mg/l (sensibilidad, 60 %; especificidad, 77,8 %).

Conclusión

La procalcitonina es un marcador de mayor rentabilidad diagnóstica que la PCR en la detección de infección bacteriana invasiva en el lactante febril incluso de forma precozen evoluciones inferiores a 12 h.

Palabras clave:
Procalcitonina
Proteína C reactiva
Infección bacteria-na invasiva
Lactante
Fiebre
Background

Procalcitonin (PCT) it is a new marker of bacterial infection. Because of its shorter half-life and earlier ascent it offers advantages over C-reactive protein (CRP).

Objective

To compare the diagnostic performance of PCT in the early detection of invasive bacterial infection in infants with that of CPR.

Material and method

Between January of 1998 and February of 2000 we performed a prospective observational study in the emergency department of infants aged between 1 and 36 months whohad been treated for fever and for whom PCT and CRP plasmatic values had been obtained. Plasmatic PCT and PCR values were evaluated and correlated with the final diagnosis. ROC curves for both markers were calculated.

Results

One hundred infants with a mean age of 8.8 months (SD = 7.59) were included in four groups of 25 patients each (viral infection, localized bacterial infection, invasive bacterial infection and control group). The mean PCT and CRP values in invasive bacterial infections [PCT: 14.45 ng/mL (SD = 27.95) and CRP: 95.10 mg/L (SD = 7 2.77)] were significantly higher than in non-invasive infections [PCT: 0.27 ng/mL (SD = 0.19) and CRP: 25.67 mg/L (SD = 33.04)] but the diagnostic performance of PCT was better. The area under the curve for PCT was 0.95 (SD = 0.03), which was significantly higher (p < 0.001) than that obtained for CRP [0.81 (SD = 0.05)]. The optimal cut-off for PCT was > 0.4 ng/mL (sensitivity: 95.5 %; specificity: 86.4%) and that for CRP was > 42.9 mg/L (sensitivity: 75 %; specificity: 81.8 %). In infants who had fever for less than 12 hours (n = 30) the area under the curve for PCT was 0.90 (SD = 0.06), which was higher (p < 0.001) than that for PCR [0.64 (SD = 0.11)]. The optimal cut-off for PCT in this group was > 0.4 ng/mL (sensitivity: 90 %; specificity: 94 %) and that for CRP was > 26.6 mg/L (sensitivity: 60 %; specificity: 77.8 %).

Conclusions

The diagnostic performance of PCT was higher than that of CRP in the early detection of invasive infectionin febrile infants, even when evolution was less than 12 hours.

Key words:
Procalcitonin
C-reactive protein
Invasive bacterial in-fection
Infant
Fever
El Texto completo está disponible en PDF
Bibliografía
[1.]
D. Gendrel, J. Raymond, J. Coste, F. Moulin, M. Lorrot, S. Guerin.
Comparison of procalcitonin with C-reactive protein, inter-leukin 6 and interferon-alpha for differentiation of bacterial vs.viral infections.
Pediatr Infect Dis J, 18 (1999), pp. 875-881
[2.]
D. Gendrel, C. Bohuon.
Procalcitonin as a marker of bacterialinfection.
Pediatr Infect Dis J, 19 (2000), pp. 679-688
[3.]
M. Assicot, D. Gendrel, H. Carsin, J. Raymond, J. Guilbaud, C. Bohuhon.
High serum procalcitonin concentrations in patients with sepsis and infection.
Lancet, 341 (1993), pp. 515-518
[4.]
Meisner M. Procalcitonin. A new innovative marker for severeinfection and sepsis. Biochemical and clinical aspects. BrahmsDiagnostica 1996: 14-21
[5.]
Becker KL, Nylen ES, Thompson KA. Preferential hypersecre-tion of procalcitonin and its precursors in pneumonitis: a cyto-kine-induced phenomenonα Filadelfia, Endotoxemia andSepsis Congress, 1995; 19-20
[6.]
M. Meisner, K. Tschaikowsky, C.H. Spiebl, J. Schüttler.
Procalcito-nin- a marker or modulator of acute immune responseα.
Inten-sive Care Med, 22 (1996), pp. 14
[7.]
P. Dandona, D. Nix, M.F. Wilson, A. Aljada, J. Love, M. Assicot, et al.
Procalcitonin increase after endotoxin injection in normal sub-jects.
J Clin Endocrinol Metab, 93 (1994), pp. 54-58
[8.]
S. Petijean, A. Mackensen, R. Engelhardt, C. Bohuon, M. Assicot.
Induction de la procalcitonine circulante après administration intraveineuse d’endotoxine chez l’homme.
Act Parm Biol Clin, 14 (1994), pp. 265-268
[9.]
I. De Werra, C. Jaccard, S.B. Corradin, R. Chiolero, B. Yersin, H. Gallati.
Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors and procalcitonin concentrations: comparisons in patients with septic shock, cardiogenic shock and bacterial pneumonia.
Crit Care Med, 25 (1997), pp. 607-613
[10.]
U. Boeken, P. Feindt, T. Petzold, M. Klein, M. Micek, U.T. Seyfert.
Diagnostic value of procalcitonin: the influence of cardio-pulmonary bypass, aprotinin, SIRS, and sepsis.
Thorac Cardio-vasc Surg, 46 (1998), pp. 348-351
[11.]
O. Mimoz, J.F. Benoist, A.R. Edouard, M. Assicot, C. Bohuon, K. Samii.
Procalcitonin and C-reactive protein during the early post-traumatic systemic inflamatory response syndrome.
IntensiveCare Med, 24 (1998), pp. 185-188
[12.]
J.F. Benoist, O. Mimoz, M. Assicot.
La procalcitonine dans les trau-matisme sévères.
Ann Biol Clin, 56 (1998), pp. 571-574
[13.]
H.B. Reith, U. Mittelkötter, E.S. Debus, C. Küssner, A. Thiede.
Pro-calcitonin in early detection of postoperative complications.
Dig Surg, 15 (1998), pp. 260-265
[14.]
M. Meisner, K. Tschaikowsky, J. Schmidt, J. Schüttler.
Procalcito-nin (PCT). Indications for a new diagnostic parameter of severe bacterial infection and sepsis in transplantation, immunosup-pression, and cardiac assist devices.
Cardiovasc Eng, 1 (1996), pp. 67-76
[15.]
E.R. Kuse, I. Langefeld, K. Jaeger, W.R. Külpmann.
Procalcitonin-a new diagnostic tool in complications following liver transplan-tation.
Intensive Care Med, 26 (2000), pp. S187-S192
[16.]
M. Lobe, S. Locziewski, F.M. Brunkhorst, C. Harke, R. Hetzer.
Pro-calcitonin in patients undergoing cardiopulmonary bypass in open heart surgery-first results of the procalcitonin in heart surgery study (prohearts).
Intensive Care Med, 26 (2000), pp. S193-S198
[17.]
C.Y. Bitkover, L.O. Hansson, G. Valen, J. Vaage.
Effects of cardiac surgery on some clinically used inflammation markers and pro-calcitonin.
Scand Cardiovasc J, 34 (2000), pp. 307-314
[18.]
Y. Gerad, D. Hober, S. Petijean, M. Assicot, C. Bohuon, Y. Mouton.
High serum procalcitonin level in a 4-year old liver trans-plant recipient with disseminated candidiasis.
Infections, 11 (1995), pp. 47-50
[19.]
C. Berger, J. Uehlinger, D. Ghelfi, N. Blau, S. Fanconi.
Comparison of C-reactive protein and white blood cell count with differen-tial in neonates at risk for septicaemia.
Eur J Pediatr, 154 (1995), pp. 138-144
[20.]
D. Gendrel, M. Assicot, J. Raymond, F. Moulin, C.H. Francoual, J. Badoual, et al.
Procalcitonin as a marker for the aerly diagno-sis of neonatal infection.
J Pediatr, 4 (1996), pp. 570-573
[21.]
G. Monneret, J.M. Labaune, C. Isaac, F. Bienvenu, G. Putet, A.J. Bien-venu.
Procalcitonin and C-reactive protein levels in neonatal infections.
Acta Paediatr, 85 (1997), pp. 209-212
[22.]
C. Chiesa, A. Panero, N. Rossi, M. Stegagno, M. De Giusti, J.F. Osborn, et al.
Reliability of procalcitonin concentrations for the diag-nosis of sepsis in critically ill neonates.
Clin Infect Dis, 26 (1998), pp. 664-672
[23.]
A.R. Franz, M. Kron, F. Pohlandt, G. Steinbach.
Comparison of pro-calcitonin with interleukin-8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infec-tions in newborn infants.
Pediatr Infect Dis J, 18 (1999), pp. 666-671
[24.]
D. Gendrel, J. Raymond, M. Assicot, F. Moulin, J.L. Iñiguez, P. Lebon, et al.
Measurement of procalcitonin levels in children with bacterial or viral meningitis.
Clin Infect Dis, 24 (1997), pp. 1240-1242
[25.]
D. Gendrel, C. Bohuon.
Procalcitonin in pediatrics for differen-tiation of bacterial and viral infections.
Intensive Care Med, 26 (2000), pp. S178-V
[26.]
D. Gendrel.
Infection urinaire et marqueurs biologiques: protéi-ne C réactive, interleukines et procalcitonine.
Arch Pédiatr, 5 (1998), pp. 269-273
[27.]
N. Benador, C.A. Siegrist, D. Gendrel, C. Greder, D. Benador, M. Assicot, et al.
Procalcitonin is a marker of severity of renal lesions in pyelonephritis.
Pediatrics, 102 (1998), pp. 1422-1425
[28.]
M. Hatherill, S.M. Tibby, K. Sykes, C. Turner, I.A. Murdoch.
Diag-nostic markers of infection: comparison of procalcitonin with Creactive protein and leucocyte count.
Arch Dis Child, 81 (1999), pp. 417-421
[29.]
J. Casado Flores F, A. Blanco Quirós.
Procalcitonina: un nuevo mar-cador de infección bacteriana.
An Esp Pediatr, 54 (2001), pp. 69-73
Copyright © 2001. Asociación Española de Pediatría
Descargar PDF
Idiomas
Anales de Pediatría
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?