Procalcitonin as a diagnostic marker of serious bacterial infections in febrile infants and children

Procalcitonin [PC T], a precursor of calcitonin, is a recognized marker of bacterial sepsis, and high concentrations conrrelate with the severity of sepsis. PCT has been proposed as an earlier and better diagnostic marker than C-reactive protein [CRP] and white cell count [WCC]. We aimed to evaluate the diagnostic markers of infection in critically ill children, comparing procalcitonin with C-reactive protein and leukocyte count in a pediatric intensive care unit [PICU]. Procalcitonin, C-reactive protein, and leukocyte count were measured in 125 children, median age 10.6 months, on admission to the PICU. Patients were classified as: non-infected controls [25]; viral infection [15]; localized bacterial infection without shock [25]; bacterial meningitis [10]; and septic shock [50]. Optimum sensitivity, specificity, predictive values, and area under the receiver operating characteristic [ROC] curve were evaluated. Admission procalcitonin was significantly higher in children with septic shock [median 96.5; range 3.2-750 ng/ml], compared with localized bacterial infection [3.2; 0-25 ng/ml], viral infection [0.8; 0-4.5 ng/ml], and non-infected controls [0.1; 0-4.8 ng/ml]. Children with bacterial meningitis had a median procalcitonin of 26.2 [range 7.5-120 ng/ml]. Area under the ROC curve was 0.95 for procalcitonin, 0.80 for C-reactive protein, and 0.52 for leukocyte count. Cut off concentrations for optimum prediction of septic shock were: procalcitonin > 20 ng/ml and C-reactive protein > 50 mg/liter. A procalcitonin concentration > 2 ng/ml identified all patients with bacterial meningitis or septic shock. We concluded that: In critically ill children the admission procalcitonin concentration is a better diagnostic marker of infection than C-reactive protein or leukocyte count. A procalcitonin concentration of 2 ng/ml might be useful in differentiating severe bacterial disease in infants and children

Urinary hyperglycosylated hCG As a predictive non-invasive new marker for gestational down syndrome screening

Hyperglycosylated human ehorionic gonadotrophin [HhCG] also known as invasive trophoblast antigen [ITA] is a new test. It specifically detects a unique oligosaccharide variant of hCG associated with Down syndrome pregnancies. We evaluated this test diagnosis through confirmatory studies. HhCG was measured by ELISA technique using commercial kit of Nunc-Immunolab-l Fisher Scientific [Larry 2001].In urine samples from women undergoing amniocentesis for advanced maternal age concerns at 6-12 weeks of gestation. 908 with normal karyotyping and 30 Down syndrome fetuses [28-45 years old]. As confirmation 36 pregnant women over 45 years old non karyotyped. 33 delivered normal babies and 3 delivered Down babies. The mean HhCG value was 7.3-7.7 folds higher in Down syndrome at 6-8 weeks gestation and 7.8-9.5 folds at 9-12 weeks gestation for women 28-45 years old. While it was 6.7 folds higher at 6-8 weeks gestation and 9.8 folds higher at 9-12 weeks gestation for women over 45 years old with Down syndrome babies. Urinary HhCG could be a new predictive non invasive marker for Down syndrome screening in the 1[st] trimester when 8-9 folds higher than normal on adding the advanced maternal-age risk factor. It can be an alternative to amniocentesis, this was a small study, thus the best clinical value of test can be established in large trials