Utility of Blood Markers in Early Prediction of Bacteraemia in Acute Febrile Paediatric Patients ??? An Observational Cohort Study in a Tertiary Care Hospital of North India

Author(s): Rabindra Bhunia1, Bindu T. Nair2, Vandana Negi3

Bacteraemia is a common cause of children presenting to the paediatric
emergency with acute febrile illness. Blood cultures remain the gold standard for
detection of bacteraemia but the positivity is low and also takes time to show
positive results. A rapid and reliable biomarker like procalcitonin (PCT), C-reactive
protein (CRP), total leucocyte count (TLC), and neutrophil-lymphocyte count ratio
(NLCR) can be used to identify febrile children with greater risk for bacteraemia
or serious bacterial infections. This would be very helpful to start early treatment
of bacteraemia with antibiotics.
The study was an observational cohort study conducted in the Department of
Paediatrics of a tertiary care hospital in North India in children between age group
6 months to 12 years presenting with fever of > 100.4° F for 2 - 7 days. Blood
samples were sent for PCT, CRP, TLC, NLCR and blood cultures.
The most sensitive biomarker was total leukocyte count (47.36 %) followed by the
neutrophil percentage (26.32 %), C-reactive protein (21.05 %), and procalcitonin
(15.79 %). The most specific biomarker was procalcitonin (75.14 %) followed by
C-reactive protein (58.56 %), neutrophil percentage (22.65 %) and total leukocyte
count (11.05 %). The only biomarker that was statistically significant between the
bacteraemia and non-bacteraemia group in the present study was total leukocyte
count (P – value < 0.05).
The sensitivity and specificity of each single biomarker is low and hence these
cannot be used singly to predict bacteraemia. There should be a combination of
biomarkers with adequate sensitivity and specificity that can be used to create an
algorithm to aid in diagnosis and prognostication.