Procalcitonin levels as a predictor of antibiotic treatment in pediatric diabetic ketoacidosis.

BACKGROUND

Procalcitonin is a useful screen for bacterial infection, but its utility in pediatric diabetic ketoacidosis (DKA) is unknown.

METHODS

We conducted a retrospective study of DKA patients admitted to two pediatric hospitals in 2019-2023.

RESULTS

116 admissions had available procalcitonin levels, of which in 32, patients were prescribed a complete antibiotics course and thus presumed to have a bacterial infection. More of the treated group were female (69% vs. 45%, p = 0.036), febrile (47% vs. 22%, p = 0.013), and/or had pneumonia on chest x-ray (30.8% vs. 4.76%, p = 0.023). Area under (AUC) a receiver operating characteristic (ROC) curve for procalcitonin to predict clinically suspected infection was 0.51 (no predictive value), whereas a ROC curve using fever and C-reactive protein (CRP) as predictors had an AUC of 0.79. Including procalcitonin in this model did not improve AUC.

CONCLUSIONS

CRP and fever are useful predictors for clinically suspected infection in DKA patients, but procalcitonin is not.