Elevated procalcitonin as a diagnostic marker in meningococcal disease.

Patients with meningococcal disease who seek medical attention can create a diagnostic dilemma for clinicians due to the nonspecific nature of the disease's presentation. This study assesses the diagnostic accuracy of procalcitonin levels in the setting of meningococcal disease. Two emergency department cohorts (A and B) were studied between 2002 and 2005, during the current epidemic of serogroup B meningococcal disease in New Zealand. Cohort A consisted of 171 patients, all with confirmed meningococcal disease (84 children, 87 adults). Cohort B consisted of a large (n=1,524) consecutively recruited population of febrile patients who presented to the emergency department, 28 of whom had confirmed meningococcal disease. Within the meningococcal disease cohort (cohort A), the geometric mean procalcitonin level was 9.9 ng/ml, with levels being higher in children than in adults (21.6 vs. 4.6 ng/ml, p=0.01). The overall sensitivity of elevated procalcitonin, using a cutoff of 2.0 ng/ml in children and 0.5 ng/ml in adults, was 0.93 (95%CI: 0.88-0.96). Despite the higher cutoff level for paediatric patients, a trend towards greater sensitivity existed in children (0.96 vs. 0.90; p=0.08). Elevated procalcitonin was correlated with whole blood meningococcal load (r=0.50) and Glasgow Meningococcal Sepsis Prognostic Score (r=0.40). Within the cohort of patients who were febrile on presentation (cohort B), the specificity of elevated procalcitonin in meningococcal disease was 0.85 (95% CI: 0.83-0.87), the positive and negative likelihood ratios were 6.1 and 0.08, respectively, and the sensitivity of elevated procalcitonin (0.93; 95% CI: 0.76-0.99) was corroborated. Measurement of procalcitonin is a useful tool in patients with nonspecific febrile illnesses when the possibility of meningococcal disease is present. The diagnostic accuracy surpasses that of current early laboratory markers, allowing results to be used to guide decisions about patient management.

Effects of repeated courses of daily steroids and of persistent proteinuria on linear growth in children with nephrotic syndrome.

The growth-inhibitory effects of courses of daily steroid therapy and of persistent proteinuria were assessed in 125 Indian and African children with nephrotic syndrome (NS) who were followed for an average of 3.9 years (range 0.25-14 years). Among the biopsied patients, 81% of Indians had minimal--change nephropathy and 49% of Africans had membranous nephropathy. The mean height standard deviation score (SDS) in 87 children who had received prednisone for an average of 36 weeks (range 4-250 weeks) was compared with that in 38 patients who had been managed symptomatically. Heights of untreated African children with persistent proteinuria were within the normal range for age, race and sex. The height SDS +/- SD for 77 Indian children in the prednisone-treated group was -1.06 +/- 1.44, which was not significantly different from -0.92 +/- 0.96 observed among 6 children in the untreated group (P = 0.75). In Africans the height SDS in 10 prednisone-treated children was -1.82 +/- 0.81 which was similar to that observed (P = 0.74) in 32 untreated patients -1.77 +/- 1.61. No significant correlation was found between the duration of prednisone therapy and height SDS for individual children among the 87 treated patients using regression analysis. The findings remained unchanged when children who had received less than 12 weeks of prednisone were excluded, or when comparison were drawn between those treated for less than and longer than 36 weeks. We conclude that courses of daily steroids or persistent proteinuria do not inhibit linear growth in Indian and African children with NS.