Related Experiment Videos
Procalcitonin is persistently increased among children with poor outcome from bacterial sepsis
Yong Y Han1, Lesley A Doughty, Danny Kofos
1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Insights
Procalcitonin levels are persistently elevated in children with bacterial sepsis and poor outcomes. This marker may help identify severe bacterial infections and predict mortality in pediatric intensive care.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Biomarker research
Background:
- Sepsis is a life-threatening condition in children.
- Bacterial infections are a common cause of sepsis and mortality.
- Identifying reliable biomarkers for sepsis severity is crucial.
Purpose of the Study:
- To investigate the relationship between procalcitonin levels and bacterial infection, sepsis-induced multiple organ failure, and mortality in children.
- To differentiate procalcitonin response in bacterial versus non-bacterial sepsis.
Main Methods:
- A cohort study was conducted in a pediatric intensive care unit.
- Seventy-eight children with sepsis or septic shock and 12 controls were included.
- Plasma procalcitonin concentrations were measured on days 1 and 3.
Main Results:
- Procalcitonin levels were significantly elevated in children with sepsis on day 1 compared to controls.
- Bacterial sepsis showed a particularly robust increase in procalcitonin on days 1 and 3.
- Persistently increased procalcitonin correlated with multiple organ failure and mortality in bacterial sepsis.
Conclusions:
- Procalcitonin is a useful indicator of poor outcomes in pediatric bacterial sepsis.
- Further research is needed to understand the role of procalcitonin in bacterial sepsis-induced organ failure and mortality.
Objective:
To examine the relationships between procalcitonin, bacterial infection, sepsis-induced multiple organ failure, and mortality rate in children.
Design:
Cohort study.
Setting:
A multidisciplinary, tertiary-care pediatric intensive care unit.
Patients:
Seventy-eight children meeting criteria for sepsis or septic shock and 12 critically ill children without sepsis.
Interventions:
Venous or arterial blood sampling.
Measurements And Main Results:
Demographic, epidemiologic, and outcome data were recorded. Plasma from children with sepsis were collected on days 1 and 3, and procalcitonin concentrations were measured by immunoluminometric assay. Organ failure index scores were determined, and multiple organ failure was defined as organ failure index > or = 3. Persistent multiple organ failure was defined by presence of multiple organ failure on day 3. Procalcitonin concentrations (median [25th percentile-75th percentile]) were increased among children with sepsis on day 1 (2.4 ng/mL [0.2-24.2], p < .01) but not on day 3 (0.8 ng/mL [0.1-8.1], p = nonsignificant) vs. controls (0.2 ng/mL [0.1-0.5]). This increase in procalcitonin concentration was particularly robust among children with bacterial sepsis on day 1 (7.1 ng/mL [0.9-44.8], p < .001) and on day 3 (2.9 ng/mL [0.1-32.4], p < .05). Procalcitonin concentrations were not increased among children with fungal, viral, or culture-negative sepsis vs. controls. Procalcitonin concentrations were persistently increased over time among patients with bacterial sepsis who had persistent multiple organ failure (p < .05) and who died (p < .01) but not among patients with nonbacterial sepsis.
Conclusions:
Procalcitonin is persistently increased among children with poor outcome from bacterial sepsis. Further study is needed to better delineate this differential procalcitonin response to bacterial vs. nonbacterial sepsis and to characterize any mechanistic role that procalcitonin might play in the development of bacterial sepsis-induced multiple organ failure and mortality.