Biomarkers for Diagnosing Disease Severity in Community-Acquired Pneumonia :

We all wish there were a simple way to predict which children with community-acquired pneumonia will progress to worsening illness. How good are the many biomarkers that are available in predicting disease severity?  Florin et al (10.1542/peds.2019-3728) share the results of a prospective study of 477 children ages 3 months to 18 years who presented to the emergency department with a community acquired pneumonia –a subset of which were confirmed with chest x-ray. The authors used disease severity as the primary outcome from mild (being discharged home) to severe (being in an intensive care unit with evidence of sepsis). The authors looked at various biomarkers including white blood cell count, absolute neutrophil count, C-reactive protein (CRP), and procalcitonin and found that none of these did very well distinguishing between severe and non-severe disease. However, after controlling for factors such as age, antibiotic usage, duration of fever, and if a viral pathogen were detected, the authors noted there could be a role for CRP being a harbinger for moderate to severe disease, and that elevated CRP and procalcitonin levels were associated more often with severe complications including empyema and sepsis. Are you using these biomarkers to help you decide severity in your patients with community acquired pneumonia, or better yet would you do so after carefully reviewing the data in this study?  We’d love to hear from you as to the utility of these biomarkers for your own patients before or after reading this study by sharing your thoughts in a comment to us via our blog, website, Facebook or Twitter sites.