Evaluation of the utilisation of semi-quantitative procalcitonin versus C-reactive protein for the diagnosis of infection in a Hospital paediatric population,with particular reference to utilisation in suspected bacterial meningitis.

Abstract

Background: The high mortality and morbidity due to bacterial infections such as meningitis, alongside the long turnaround times for gold standard microscopy and culture testing, warrants alternative laboratory tests such as C-reactive protein (CRP) and procalcitonin(PCT), which demonstrate adequate test sensitivity and specificity. In addition, there is a need for more studies a in Africa, which will show the diagnostic value of CRP and PCT in bacterial infections. The aims of this study were a) to describe the utilisation of semiquantitative serum PCT in aiding with the diagnosis of bacterial infections in a South African paediatric population and b) to compare the utility of PCT in a subset of patients with suspected bacterial meningitis. Methods A retrospective observational study with charts review was done. It included data for all paediatric patients admitted to the King Edward Hospital (Durban, South Africa) for which semi quantitative PCT testing was performed for the period April 2013- April 2016. Descriptive statistical methods were employed for the analysis of data. Results The semi-quantitative PCT results correlated well with the serum CRP levels and showed significant correlation with extent of rise in CRP. A statistically significant (p=0.035) difference of median CRP levels across different categories of PCT levels, with higher values associated with PCT categories associated with greater degrees of infection. Kappa statistic analysis performed to determine agreement between positive and negative culture results with positive and negative semi quantitative PCT results, showed poor observed agreement of 53.13% (acceptable >75%). Conclusions Findings of the current study do not demonstrate added benefit of use of semi-quantitative PCT over traditional CRP. Further studies will need to be done to examine utility of the semiquantitative PCT test for early diagnosis specific bacterial infections including meningitis and pneumonia in this specific population.