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Combined use of procalcitonin and C-reactive protein levels can help clinically diagnose bacterial co-infections in children infected with H1N1 influenza

Objective This study evaluated the diagnostic value of measuring the levels of procalcitonin (PCT) and C-reactive protein (CRP) to differentiate children co-infected with H1N1 influenza and bacteria from children infected with H1N1 influenza alone and to provide a reliable clinical diagnostic support system with improved accuracy and precision control. Methods Consecutive patients (children aged <5 years) with laboratory-confirmed H1N1 influenza who were hospitalized or received outpatient care from a tertiary-care hospital in Canton, China between 1 January 2012 and 1 September 2017 were included in the present study. Laboratory results, including serum PCT and CRP levels, white blood cell (WBC) counts, and blood and sputum cultures, were analyzed. The predictive value of the combination of biomarkers versus either biomarker alone for diagnosing bacterial co-infections was evaluated using logistic regression analyses. Results Of 3180 children infected with H1N1 influenza, 226 (7.1%) met the bacterial co-infection criteria, with Staphylococcus pneumoniae being the most commonly identified bacteria (36.28%). Significantly higher PCT (1.46 vs 0.21 ng/ml, p<0.001) and CRP (19.20 vs 5.10 mg/dl, p<0.001) levels were detected in the bacterial co-infection group than in the H1N1 infection only group. Multivariate logistic regression analysis showed independent associations between PCT (odds ratio [OR]: 1.73, 95% confidence interval [CI],1.34-2.42, p<0.001) and CRP levels (OR:1.09, 95% CI, 1.06-1.13, p<0.001) with bacterial co-infections. Using PCT or CRP levels alone, the areas under the curves (AUCs) for predicting bacterial co-infections were 0.801 (95%CI, 0.772-0.855) and 0.762 (95%CI, 0.722-0.803), respectively. Using a combination of PCT and CRP, the logistic regression-based model, Logit(P)=-1.912+0.546 PCT+0.087 CRP, showed significantly greater accuracy (AUC: 0.893, 95%CI: 0.842-0.934) than did the other three biomarkers. Conclusions The combination of PCT and CRP levels could provide a useful method of distinguishing bacterial co-infections from an H1N1 influenza infection alone in children during the early disease phase. After further validation, the flexible model derived here could assist clinicians in decision-making processes.