Emerging and Established Biomarkers in Pediatric Pneumonia for Diagnostic Prognostic and Therapeutic Implications
Keywords:
Pediatric pneumonia; Biomarkers; Procalcitonin; C-reactive protein; CytokinesAbstract
Pneumonia is one of the most common causes of morbidity and mortality in children across the globe especially in low and middle income nations. Timely and proper distinction between bacterial and viral etiologies is needed to maximize the treatment, minimize complications, and promote antimicrobial stewardship. Nevertheless, the clinical manifestation and traditional radiographic observations is not specific enough to classify etiologically and predict the severity. Biomarkers have consequently become important supplements in diagnosis and prognosis of pneumonia in children. C-reactive protein (CRP), procalcitonin (PCT) and leukocyte indices are all standard inflammatory markers that have been broadly used in clinical practice. CRP and PCT have moderate diagnostic value, and PCT is more specific to bacterial infection, and can be used to inform antibiotic treatment. The cytokines such as interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) indicate the severity of the disease and are correlated with the intensive care admission and the risk of complications.
The new biomarkers like presepsin and serum amyloid A (SAA) have potential in enhancing etiological discrimination and prognostic evaluation. Simultaneously, the expression profiling of host genes and molecular pathogen detection with the help of polymerase chain reaction improves the diagnostic sensitivity but should be carefully interpreted because of the colonization and resource restrictions. Even though no individual biomarker can offer unconditional etiological distinction, multi-marker approaches in combination with the clinical assessment and imaging results offer an enhanced predictive efficiency. Further studies in areas of integrated biomarker panels, fast point-of-care diagnostics, and precision-based algorithms are needed to improve the quality of the diagnostic and manage pediatric pneumonia better around the world.
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