The Medical journal of Malaysia · 2026
Diagnostic accuracy of procalcitonin for identifying paediatric sepsis: A retrospective study in a Malaysian tertiary hospital.
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Razak S M A, Taib M N A, Abdul Jalil K, Arifin R, Nik Wan N S
Аннотация
INTRODUCTION: Early diagnosis of paediatric sepsis remains challenging because clinical manifestations are non-specific and microbiological culture results are often delayed. Procalcitonin (PCT) has emerged as a promising biomarker for bacterial infection; however, its diagnostic performance varies across patient populations and clinical settings. This study evaluated the diagnostic accuracy of serum PCT for identifying paediatric sepsis in a Malaysian tertiary referral hospital.
MATERIALS AND METHODS: A retrospective descriptive study was conducted at Hospital Sultanah Nur Zahirah, Terengganu, Malaysia, between June 2022 and June 2024. Children aged 1 month to 18 years who underwent serum PCT testing for suspected infection were included. Paediatric sepsis was classified according to the 2005 International Paediatric Sepsis Consensus Conference criteria, supported by microbiologically confirmed infection or a Phoenix Sepsis Score ≥2 in culture-negative cases. Serum PCT, C-reactive protein (CRP), and total white cell count (TWC) obtained at initial presentation were analysed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, predictive values, likelihood ratios, and diagnostic odds ratio.
RESULTS: A total of 242 children were included, of whom 129 (53.3%) were classified as having sepsis. Median PCT concentrations were significantly higher in the sepsis group than in the non-sepsis group (1.940 vs. 0.240 ng/mL; p < 0.0001). At a cut-off value of 0.5 ng/mL, PCT demonstrated a sensitivity of 76.0%, specificity of 73.5%, positive predictive value of 76.6%, negative predictive value of 72.8%, positive likelihood ratio of 2.86, negative likelihood ratio of 0.33, and diagnostic odds ratio of 8.75. ROC analysis showed moderate diagnostic accuracy with an area under the curve of 0.747 (95% confidence interval: 0.692-0.802). PCT demonstrated a moderate positive correlation with CRP (Spearman's r = 0.546) but no significant correlation with TWC.
CONCLUSION: Serum PCT demonstrated moderate diagnostic accuracy for identifying paediatric sepsis and may serve as a useful adjunctive biomarker for the early evaluation of children with suspected sepsis. However, PCT should be interpreted alongside clinical assessment and microbiological investigations rather than used as a standalone diagnostic test.
MATERIALS AND METHODS: A retrospective descriptive study was conducted at Hospital Sultanah Nur Zahirah, Terengganu, Malaysia, between June 2022 and June 2024. Children aged 1 month to 18 years who underwent serum PCT testing for suspected infection were included. Paediatric sepsis was classified according to the 2005 International Paediatric Sepsis Consensus Conference criteria, supported by microbiologically confirmed infection or a Phoenix Sepsis Score ≥2 in culture-negative cases. Serum PCT, C-reactive protein (CRP), and total white cell count (TWC) obtained at initial presentation were analysed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, predictive values, likelihood ratios, and diagnostic odds ratio.
RESULTS: A total of 242 children were included, of whom 129 (53.3%) were classified as having sepsis. Median PCT concentrations were significantly higher in the sepsis group than in the non-sepsis group (1.940 vs. 0.240 ng/mL; p < 0.0001). At a cut-off value of 0.5 ng/mL, PCT demonstrated a sensitivity of 76.0%, specificity of 73.5%, positive predictive value of 76.6%, negative predictive value of 72.8%, positive likelihood ratio of 2.86, negative likelihood ratio of 0.33, and diagnostic odds ratio of 8.75. ROC analysis showed moderate diagnostic accuracy with an area under the curve of 0.747 (95% confidence interval: 0.692-0.802). PCT demonstrated a moderate positive correlation with CRP (Spearman's r = 0.546) but no significant correlation with TWC.
CONCLUSION: Serum PCT demonstrated moderate diagnostic accuracy for identifying paediatric sepsis and may serve as a useful adjunctive biomarker for the early evaluation of children with suspected sepsis. However, PCT should be interpreted alongside clinical assessment and microbiological investigations rather than used as a standalone diagnostic test.