Diagnostic Value of Presepsin, CRP and Procalcitonin as Markers of Infection in Children with Community-Acquired Pneumonia

Year 2025, Volume: 4 Issue: 2, 53 - 58, 30.06.2025

Ayyüce Ünlü , Necdet Kuyucu , Asuman Akar , Edanur Yeşil , Didem Derici

Abstract

Introductıon: Community-acquired pneumonia (CAP) is a common pediatric infection desaese.Biomarkers such as C-reactive protein (CRP) and procalcitonin are frequently used for diagnosis and disease monitoring. Presepsin, has emerged as a novel marker involved in the early immune response to bacterial infections. This study aimed to evaluate the diagnostic value of CRP, procalcitonin, and presepsin in children with CAP.

Methods: A total of 61 children aged 1 month to 17 years were included in this prospective observational study conducted between December 5, 2018, and December 5, 2019. Thirty-seven patients with clinically and radiologically confirmed CAP who were admitted to the Pediatric Outpatient Clinics and Pediatric Emergency Department of Mersin University Faculty of Medicine Hospital, and 24 healthy age-matched children without chronic diseases were enrolled. Detailed demographic, clinical, laboratory, and radiological data were collected. Biomarker levels were measured at the time of diagnosis.

Results: The mean age of patients was 4.3±4.7 years, and 51% were female; the control group had a mean age of 9.6±4.1 years. The most common symptoms were cough (94.6%), fever (75.7%), and wheezing (32.4%). Chest radiography showed lobar pneumonia in 29.7% and interstitial/bronchial pneumonia in 70.3% of cases. CRP, procalcitonin, and presepsin levels were significantly higher in the CAP group than in controls (p<0.001, p<0.001, p=0.001).

Conclusion:CRP and procalcitonin remain valuable markers in diagnosing and managing pediatric CAP. Although presepsin demonstrated high specificity, its lower sensitivity limits its role as a primary diagnostic marker.It may, however, serve as a supportive tool in select clinical settings.

Keywords

C-reactive protein , Pediatric , Pneumonia , Presepsin , Procalcitonin

References

• 1.Perin J, Mulick A, Yeung D, Villavicencio F, Lopez G, Strong KL, Prieto-Merino D, Cousens S, Black RE, Liu L. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022 Feb;6(2):106-115. doi: 10.1016/S2352-4642(21)00311-4. Epub 2021 Nov 17. Erratum in: Lancet Child Adolesc Health. 2022 Jan;6(1):e4. PMID: 34800370; PMCID: PMC8786667.
• 2.Klein, J. Bacterial pneumonias. in Textbook of Pediatric Infectious Diseases W.B. Saunders Company, 2004:273-84.
• 3.Korppi M. Non-specific host response markers in the differentiation between pneumococcal and viral pneumonia: what is the most accurate combination? Pediatr Int. 2004 Oct;46(5):545-50. doi: 10.1111/j.1442-200x.2004.01947.x. PMID: 15491381
• 4.Chenevier-Gobeaux C, Borderie D, Weiss N, Mallet-Coste T, Claessens YE. Presepsin (sCD14-ST), an innate immune response marker in sepsis. Clin Chim Acta. 2015;450:97-103.
• 5.Yang HS, Hur M, Yi A, Kim H, Lee S, Kim SN. Prognostic value of presepsin in adult patients with sepsis: Systematic review and meta-analysis. PLoS One. 2018 Jan 24;13(1):e0191486.
• 6.Alam JM, Sherwani SK, Hussain A, Matinuddin S, Kausar R, Ahmed A et al. Comparative assessment of analytical performance of conventional chemistry analyzer and modular Cobas 6000 system using routine chemistry parameters. Middle-East Journal of Scientific Research. 2014;21(8):1283-7.
• 7.Wu CC, Lan HM, Han ST, et al. Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and C-reactive protein: a systematic review and meta-analysis. Ann. Intensive Care 2017;7: 91.
• 8.Özdoğan Ş. Approach to community-acquired pneumonia in children: American pediatric infection society guidelines. SiSli Etfal Hastan Tip Bul Med Bull Sisli Hosp 2015;85-95 doi:10.5350/SEMB.20150831060742.
• 9.Tulek, B., Koylu, H., Kanat, F., Arslan, U. & Ozer, F. Serum C-reactive protein and procalcitonin levels in non-small cell lung cancer patients. Współczesna Onkol. 2013;1:68-72.
• 10.Park J, Yoon JH, Ki HK, Ko JH, Moon HW. Performance of presepsin and procalcitonin predicting culture-proven bacterial infection and 28-day mortality: A cross sectional study. Front Med (Lausanne). 2022 Aug 22;9:954114. doi: 10.3389/fmed.2022.954114. PMID: 36072944; PMCID: PMC9441687.
• 11.Landmann R, Zimmerli W, Sansano S, et al. Increased circulating soluble CD14 is associated with high mortality in gram-negative septic shock. J Infect Dis. 1995 Mar;171(3):639-44.
• 12.Karakioulaki, M. & Stolz, D. Biomarkers in Pneumonia-Beyond Procalcitonin. Int. J. Mol. Sci. 2019;20: 2004.
• 13.Lee JY, Hwang SJ, Shim JW, et al. Clinical significance of serum procalcitonin in patients with community-acquired lobar pneumonia. Korean J Lab Med. 2010 Aug;30(4):406-13.
• 14.Noh, S. H., Park, S. D. & Kim, E. J. Serum Procalcitonin Level Reflects the Severity of Cellulitis. Ann. Dermatol. 2016;28; 704.
• 15.Olad E, Sedighi I, Mehrvar A, et al. Presepsin (scd14) as a marker of serious bacterial infections in chemotherapy induced severe neutropenia. Iran J Pediatr. 2014 Dec;24(6):715-22.
• 16.Agnello L, Bellia C, Di Gangi M, et al. Utility of serum procalcitonin and C-reactive protein in severity assessment of community-acquired pneumonia in children. Clin Biochem. 2016 Jan;49(1-2):47-50.
• 17.Montaldo, P., Rosso, R., Santantonio, A., Chello, G. & Giliberti, P. Presepsin for the detection of early-onset sepsis in preterm newborns. Pediatr. Res. 2017;81: 329-334.
• 18.Klouche K, Cristol JP, Devin J, et al. Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients. Ann Intensive Care. 2016Dec;6(1):59. doi: 10.1186/s13613-016-0160-6.
• 19.Póvoa P.,Coelho L, Almeida E,et al. C-reactive protein as a marker of infection in critically ill patients. Clin. Microbiol. Infect. 2005;11: 101-108.
• 20.Van Vugt SF, Broekhuizen BD, Lammens C, et al. Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. BMJ. 2013 Apr 30;346:2450.
• 21.Holm A, Pedersen SS, Nexoe J, et al. Procalcitonin versus C-reactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care. Br J Gen Pract. 2007 Jul;57(540):555-60.
• 22.Morgenthaler NG, Struck J, Fischer-Schulz C, Seidel-Mueller E, Beier W, Bergmann A. Detection of procalcitonin (PCT) in healthy controls and patients with local infection by a sensitive ILMA. Clin Lab. 2002;48(5-6):263-70.
• 23.Liaudat, S., Dayer, E., Praz, G., Bille, J. & Troillet, N. Usefulness of Procalcitonin Serum Level for the Diagnosis of Bacteremia. Eur. J. Clin. Microbiol. Infect. Dis. 2001;20; 524-527
• 24.Liu, B., Yin, Q., Chen, Y.-X., Zhao, Y.-Z. & Li, C.-S. Role of Presepsin (sCD14-ST) and the CURB65 scoring system in predicting severity and outcome of community-acquired pneumonia in an emergency department. Respir. Med. 2014;108: 1204-1213.
• 25.Halıcı A, Hür İ, Abatay K, Çetin E, Halıcı F, Özkan S. The role of presepsin in the diagnosis of chronic obstructive pulmonary disease acute exacerbation with pneumonia. Biomark Med. 2020 Jan;14(1):31-41. doi: 10.2217/bmm-2019-0183. Epub 2019 Nov 8. PMID: 31701761