Procalcitonin levels as a predictor of antibiotic treatment in pediatric diabetic ketoacidosis

BACKGROUND: Procalcitonin is a useful screen for bacterial infection, but its utility in pediatric diabetic ketoacidosis (DKA) is unknown. METHODS: We conducted a retrospective study of DKA patients admitted to two pediatric hospitals in 2019-2023. RESULTS: 116 admissions had available procalcitonin levels, of which in 32, patients were prescribed a complete antibiotics course and thus presumed to have a bacterial infection. More of the treated group were female (69% vs. 45%, p = 0.036), febrile (47% vs. 22%, p = 0.013), and/or had pneumonia on chest x-ray (30.8% vs. 4.76%, p = 0.023). Area under (AUC) a receiver operating characteristic (ROC) curve for procalcitonin to predict clinically suspected infection was 0.51 (no predictive value), whereas a ROC curve using fever and C-reactive protein (CRP) as predictors had an AUC of 0.79. Including procalcitonin in this model did not improve AUC. CONCLUSIONS: CRP and fever are useful predictors for clinically suspected infection in DKA patients, but procalcitonin is not.