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Published on: December 9, 2022
Procalcitonin in children with sepsis and septic shock
José R Fioretto1, Fernanda C Borin, Rossano C Bonatto
1Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil. jrf@fmb.unesp.br
Insights
Procalcitonin levels help differentiate pediatric sepsis from septic shock. Elevated procalcitonin in children indicates a higher likelihood of severe septic conditions and aids in diagnosis.
Area of Science:
- Pediatric critical care medicine
- Biomarker research
- Infectious disease diagnostics
Background:
- Sepsis and septic shock are life-threatening conditions in children.
- Accurate and timely diagnosis is crucial for effective treatment.
- Procalcitonin is a biomarker investigated for its role in diagnosing bacterial infections.
Purpose of the Study:
- To investigate the behavior of procalcitonin in children with septic conditions.
- To determine if procalcitonin can differentiate between sepsis and septic shock in pediatric patients.
- To explore the relationship between procalcitonin levels and disease severity.
Main Methods:
- Prospective study of children aged 28 days to 14 years admitted to a pediatric intensive care unit.
- Classification into sepsis group (SG) and septic shock group (SSG).
- Procalcitonin (PCT) levels measured at admission (T0) and 12 hours later (T12h), categorized into distinct classes based on concentration.
Main Results:
- A significantly higher proportion of septic shock patients were in the highest PCT class (> / = 10 ng/mL) at T0 compared to sepsis patients (69.7% vs. 29.8%, p < 0.05).
- PCT levels at T12h showed similar trends to T0.
- Pediatric Risk of Mortality (PRISM) scores were significantly higher in SSG patients within the highest PCT class.
Conclusions:
- Procalcitonin levels can effectively differentiate between sepsis and septic shock in children.
- Procalcitonin is a valuable aid in diagnosing septic conditions in pediatric intensive care.
- PCT levels appear to correlate with the severity of septic conditions in children.
Objective:
To study the behavior of procalcitonin and to verify whether it can be used to differentiate children with septic conditions.
Method:
Children were enrolled prospectively from among those aged 28 days to 14 years, admitted between January 2004 and December 2005 to the pediatric intensive care unit at UNESP with sepsis or septic shock. The children were classified as belonging to one of two groups: the sepsis group (SG; n = 47) and the septic shock group (SSG; n = 43). Procalcitonin was measured at admission (T0) and again 12 hours later (T12h), and the results classed as: < 0.5 ng/mL = sepsis unlikely; >/= 0.5 to < 2 = sepsis possible; >/= 2 to < 10 = systemic inflammation and >/= 10 = septic shock.
Results:
At T0 there was a greater proportion of SSG patients than SG patients in the highest PCT class [SSG: 30 (69.7%) > SG: 14 (29.8%); p < 0.05]. The proportion of SSG patients in this highest PCT class was greater than in all other classes (>/= 10 = 69.7%; >/= 2 to < 10 = 18.6%; >/= 0.5 to < 2 = 11.6%; < 0.5 = 0.0%; p < 0.05). The behavior of procalcitonin at T12h was similar to at T0. The pediatric risk of mortality (PRISM) scores for the SSG patients in the highest procalcitonin class were more elevated than for children in the SG [SSG: 35.15 (40.5-28.7) vs. SG: 18.6 (21.4-10.2); p < 0.05].
Conclusions:
Procalcitonin allows sepsis to be differentiated from septic shock, can be of aid when diagnosing septic conditions in children and may be related to severity.
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