Using biomarkers to predict CAP severity

Biomarkers have been a way of predicting community-acquired pneumonia (CAP) disease severity in adults. A new study in Pediatrics looks at whether biomarkers can help predict severe disease courses in children as well.¹

Investigators ran a prospective cohort study of children aged 3 months to 18 years who had CAP and received treatment in the emergency department. Disease severity was divided into 4 categories: mild, discharged from the hospital; mild-moderate, hospitalized but not moderate-severe or severe; moderate-severe, hospitalized and received intravenous fluids or supplemental oxygen, or complicated pneumonia; or severe, intensive case, vasoactive infusions, chest drainage, or severe sepsis.

The cohort included 477 children and there were no statistical differences in median absolute neutrophil count, C-reactive protein, procalcitonin, and white blood cell count. Investigators found that no biomarker showed adequate discriminatory ability between severe and nonsevere disease. After adjusting for age, antibiotic use, fever duration, and viral pathogen detection, C-reactive protein was linked with moderate-severe disease. Procalcitonin and C-reactive protein had good discrimination of children with sepsis with vasoactive infusions and empyema requiring chest drainage, but prevalence of these outcomes was found to be low.

Researchers concluded that overall biomarkers aren’t helpful in discriminating severe CAP from nonsevere CAP. Certain biomarkers, C-reactive protein and procalcitonin, could help predict some of the most severe outcomes.

References:

1.    Florin TA, Ambroggio L, Brokamp C, et al. Biomarkers and disease severity in children with community-acquired pneumonia. Pediatrics. 2020;145(5):e20193728. doi: 10.1542/peds.2019-3728