New diagnostic biomarker in acute diarrhea due to bacterial infection in children.

BACKGROUND AND

objectivesDiarrhea is a major cause of morbidity and mortality in children, and diarrhea may be due to infection that is bacterial or non-bacterial. Differentiation between diarrhea from a bacterial or non-bacterial infection is not a simple task, and no single method is present to differentiate between these causes of diarrhea.To evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and procalcitonin (PCT) in the diagnosis of acute diarrhea due to bacterial infection. PATIENTS AND

methodsCase control study of forty children with bacterial infection diarrhea diagnosed by stool culture and CRP, 40 children with acute non-bacterial infection diarrhea and 30 age- and sex-matched healthy controls. Stool cultures, serum CRP, PCT and serum sTREM-1 were measured in all children on admission.

resultsChildren with acute bacterial infection diarrhea had a significant increase in the serum sTREM-1 and PCT levels on admission compared to patients with nonbacterial infection diarrhea and controls (26.3667 ± 16.8184 ng/ml vs 7.2267 ± 6.4174 ng/ml vs 6.7367 ± 5.6479 ng/ml and 39.9933 ± 22.5260 ng/ml vs 1.8533 ± 1.7123 vs 0.2840 ± 0.1208 ng/ml, respectively; P < 0.05). sTREM-1 demonstrated significantly higher sensitivity (93.7%) and specificity (94.3%) in the prediction of bacterial infection as a cause of acute diarrhea in children with an area under the receiver operator characteristic (ROC) curve (95% CI) of 0.94 (0.84-0.99) at a cutoff value of 12.4 ng/ml.

conclusionsBoth serum PCT and sTREM-1 are valuable in the early diagnosis of acute bacterial infection-induced diarrhea in children, and there was markedly higher diagnostic discriminatory power for sTREM-1.