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Serum procalcitonin in children with suspected sepsis: a comparison with C-reactive protein and neutrophil count
Juan Casado-Flores1, Alfredo Blanco-Quirós, Julia Asensio
1Hospital Infantil Universitario Niño Jesuś, Madrid, Spain.
Insights
Serum procalcitonin rapidly increases in children with sepsis, offering better prognostic value than C-reactive protein or neutrophil count. This biomarker is particularly useful in severe pediatric infections and infants under 12 months.
Area of Science:
- Pediatric critical care medicine
- Clinical immunology
- Infectious diseases
Background:
- Severe infections in children, including sepsis, pose significant diagnostic and prognostic challenges.
- Accurate biomarkers are crucial for timely intervention and improved patient outcomes.
- Serum procalcitonin (PCT) is a potential biomarker for bacterial infections, but its characteristics in pediatric severe infections require further elucidation.
Purpose of the Study:
- To characterize serum procalcitonin levels in children with severe infections.
- To identify factors influencing PCT elevation in this population.
- To evaluate the prognostic utility of PCT and compare it with C-reactive protein (CRP) and neutrophil count.
Main Methods:
- Prospective observational study with 48-hour follow-up in a pediatric intensive care unit.
- Inclusion of 80 children (1 month to 16 years) suspected of sepsis.
- Measurement of serum PCT and CRP at admission and serially; assessment of clinical parameters and outcomes.
Main Results:
- Serum PCT was significantly elevated at onset in most pediatric sepsis cases (1.0-722 ng/mL) and did not increase substantially thereafter.
- PCT levels did not vary with patient age, unlike CRP.
- Higher PCT levels correlated with shock, multiple organ dysfunction syndrome, higher Pediatric Risk of Mortality scores, and mortality.
Conclusions:
- Serum procalcitonin demonstrates rapid elevation in pediatric sepsis, including infants under 12 months.
- PCT exhibits superior prognostic value compared to CRP and neutrophil count in children with severe infections.
- PCT is a valuable biomarker for assessing severity and predicting outcomes in pediatric sepsis.
Objectives:
To investigate the specific characteristics of serum procalcitonin in children with severe infection, to identify relevant factors influencing procalcitonin increase, to assess its prognostic value, and to compare it with C-reactive protein and neutrophil count
Design:
A prospective observational study and 48 hrs of follow-up of a cohort of cases.
Setting:
A pediatric intensive care unit within a children's university hospital in collaboration with a laboratory mainly involved in research in pediatric clinical immunology.
Patients:
A total of 80 children (median age, 3.1 yrs; range, 1 month to 16 yrs) admitted to a pediatric intensive care unit by suspicion of sepsis.
Interventions:
All patients were treated according to a protocol using antibiotics, fluid resuscitation, inotropic drugs, and mechanical ventilation when they presented with shock or respiratory failure.
Measurements And Main Results:
Serum procalcitonin and C-reactive protein were measured at admission in all patients and, when possible, repeated 6,12, 24, and 48 hrs later. In most cases, serum procalcitonin was already very high at onset (range, 1.0-722 ng/mL), and it did not increase significantly afterward. Contrary to C-reactive protein, serum procalcitonin did not vary according to the age of patients. The increase of procalcitonin was higher in patients with shock or multiple organ dysfunction syndrome, having a high severity score (Pediatric Risk of Mortality) or in patients who later died.
Conclusions:
Serum procalcitonin levels show a rapid increase in children with sepsis, even in infants < 12 month old, and they have a better prognostic value than C-reactive protein or neutrophil count.
