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Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock-A pilot study
Banani Poddar1, Mohan Gurjar1, Sushma Singh2
1Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
A significant reduction in procalcitonin (PCT) levels within 4 days in pediatric intensive care may indicate a better prognosis for children with severe sepsis or septic shock, suggesting its potential as a mortality predictor.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Biomarker research
Background:
- Severe sepsis and septic shock are life-threatening conditions in children.
- Early identification and prognostic markers are crucial for improving outcomes.
- Procalcitonin (PCT) is a biomarker used in sepsis management.
Purpose of the Study:
- To determine if a reduction in procalcitonin (PCT) levels is associated with 28-day mortality in pediatric patients with severe sepsis or septic shock.
- To evaluate PCT as a potential prognostic indicator in this vulnerable population.
Main Methods:
- Prospective observational study in a mixed adult-pediatric intensive care unit.
- Included children (up to 18 years) admitted with severe sepsis or septic shock.
- Measured PCT on admission (D0) and 72-96 hours later (D4); correlated PCT reduction with 28-day mortality.
Main Results:
- Twenty-five children were enrolled; 11 died within 28 days.
- Median PCT reduction was significantly greater in survivors (17.3 ng/mL) compared to non-survivors (-1.1 ng/mL) (P=.017).
- A PCT reduction >50% from D0 to D4 was observed in 75.5% of survivors versus -200.3% in non-survivors (P=.006).
Conclusions:
- A reduction in PCT levels by more than 50% in the first 4 days of intensive care may be a promising indicator of reduced mortality in children with severe sepsis or septic shock.
- Further research is warranted to validate PCT reduction as a reliable prognostic marker in pediatric sepsis.
- This pilot study highlights the potential utility of dynamic PCT monitoring in managing critically ill children.
Purpose:
To investigate if reduction in procalcitonin (PCT) provides useful information about 28-day mortality in children with severe sepsis or septic shock.
Materials And Methods:
Design: Prospective observational study.
Setting:
Mixed adult-pediatric intensive care unit in a teaching hospital.
Subjects:
Children up to 18 years of age admitted with severe sepsis or septic shock between March 2011 and June 2013. Procalcitonin measured using electrochemiluminescence immunoassay on the day of admission with sepsis (D0) and 72-96 hours later (D4). Reduction in PCT from D0 to D4 correlated with the primary outcome, that is, 28-day mortality.
Results:
Twenty-five children of median age of 14 years (range, 6-18 years) were included, but 5 died before D4 after admission. Six of the remaining 20 children died between D4 and D28, and 14 survived to D28. At admission, the median of the Pediatric Risk of Mortality III score was 10 (interquartile range [IQR], 5-16) and that of the Sequential Organ Failure Assessment score was 11 (IQR, 7-15). The median PCT level was 9.7 ng/mL on D0 (n = 25) and 3.3 ng/mL on D4 (n = 20). On D0, the median PCT level was 25.0 ng/mL in the 14 survivors and 8.4 ng/mL in the 11 nonsurvivors (P = .075). On D4, the median PCT level was 3.1 ng/mL in the 14 survivors and 4.5 ng/mL in the 6 nonsurvivors who lived to D4 (P = .71); the reduction in PCT (D0 minus D4) was 17.3 ng/mL (IQR, 3.5-38.0 ng/mL) in the survivors and -1.1 ng/mL (IQR, -24.9 to 8.6 ng/mL) in the 6 nonsurvivors (P = .017). Percent reduction in PCT (100 * [D0 - D4]/D0) was 75.5% (IQR, 54.8%-80.7%) in the survivors and -200.3% (IQR, -937.8% to 42.4%) in the 6 nonsurvivors (P = .006).
Conclusion:
This small pilot study suggests that further studies are indicated to determine whether children with severe sepsis or septic shock are less likely to die if they have a reduction in PCT more than 50% in the first 4 days in intensive care.
