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Comparison between procalcitonin and C-reactive protein for early diagnosis of children with sepsis or septic shock
José R Fioretto1, Joelma G Martin, Cilmery S Kurokawa
1Pediatrics Department, Botucatu Medical School, Sao Paulo State University, São Paulo, Brazil. jrf@fmb.unesp.br
Insights
Procalcitonin (PCT) better differentiates pediatric sepsis and septic shock than C-reactive protein (CRP) within 12 hours of admission. Higher PCT levels correlate with increased disease severity in children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Biomarker research
Background:
- Sepsis and septic shock are life-threatening conditions in children.
- Accurate early diagnosis is crucial for effective treatment.
- C-reactive protein (CRP) and procalcitonin (PCT) are inflammatory markers used in sepsis diagnosis.
Purpose of the Study:
- To compare the diagnostic performance of CRP and PCT in pediatric sepsis.
- To evaluate these biomarkers within the first 12 hours of hospital admission.
- To determine which marker better differentiates sepsis from septic shock in children.
Main Methods:
- A study involving 87 pediatric patients (28 days to 14 years) divided into sepsis and septic shock groups.
- Measurement of CRP and PCT levels at admission (T0) and 12 hours later (T12 h).
- Classification of PCT levels to indicate sepsis likelihood and severity.
Main Results:
- Procalcitonin levels were significantly higher in the septic shock group compared to the sepsis group at both T0 and T12 h (P < 0.05).
- PCT levels greater than 10 ng/ml were more frequent in septic shock patients.
- C-reactive protein levels did not show statistically significant differences between groups or over time.
- Higher PCT levels correlated with higher Pediatric Risk of Mortality I scores.
Conclusions:
- Procalcitonin is a more effective biomarker than CRP for diagnosing sepsis and septic shock in children.
- PCT demonstrates superior performance, particularly upon admission, in differentiating disease severity.
- PCT levels are directly related to the severity of sepsis in pediatric patients.
Objective And Design:
The objective of the paper is to examine the behavior of C-reactive protein (CRP) and procalcitonin (PCT) in the first 12 h of admission and verify which performs better to differentiate children with septic conditions.
Subjects:
Septic children aged between 28 days and 14 years were divided into sepsis (SG; n = 46) and septic shock (SSG; n = 41) groups. CRP and PCT were measured at admission (T0) and 12 h later (T12 h). PCT results were classed as: 0.5 ng/ml = sepsis unlikely; >or=0.5 to <2 = sepsis possible; >or=2 to <10 = systemic inflammation; >or=10 = septic shock.
Results:
At T0, there was a higher frequency of SSG with PCT >10 compared to SG [SSG: 30 (73.1%) > SG: 14 (30.4%); P < 0.05]. Similar results were observed at T12 h. Pediatric Risk of Mortality I score was significantly higher for SSG patients with higher PCT than SG patients. CRP levels were not statistically different for groups and time points.
Conclusions:
PCT was better than CRP for diagnosing sepsis and septic shock, mainly at admission, and is related to disease severity.
