Recovery from childhood community-acquired pneumonia in a developing country: Prognostic value of serum procalcitonin

Background: Childhood community-acquired pneumonia is a common and potentially life-threatening illness in developing countries. We assessed the prognostic value of serum procalcitonin level upon admission on clinical response to antibiotic treatment. Methods: Out of 89 patients, the median (IQR) age was 19(12-29) months and 60% were boys. Viral (49.5%), typical bacterial (38%) and atypical bacterial (12.5%) infections as well as probable pneumococcal infection (26%) were diagnosed. Results: Seventy-five (84%) children became afebrile <= 48 h after treatment. In 14 children who remained febrile after 48 h of treatment, median[IQR] serum procalcitonin (ng/ml) level on admission was higher than in those with rapid recovery (2.1[0.8-3.7] vs 0.6[0.1-2.2]; P = 0.025). In the slow-responding children, pneumococcal infections were more common (71% vs 17%; P < 0.001). Procalcitonin concentrations on admission were higher in children with pneumococcal pneumonia compared to children with non-pneumococcal pneumonia (2[0.7-4.2] vs 0.5[0.08-2.1]; P = 0.002). The ROC curve found that < 0.25 ng/ml of serum procalcitonin had a high negative predictive value (93%[95%CI:80%-99%]) for pneumococcal infection. All children that remained febrile after 48 h of treatment had procalcitonin > 0.25 ng/ml on admission. The majority of children with pneumonia in a developing country become afebrile within 48 h after onset of antibiotic treatment. Conclusions: Serum procalcitonin at 0.25 ng/ml predicted rapid clinical response and non-pneumococcal etiology.