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Utility of specific laboratory biomarkers to predict severe sepsis in pediatric patients with SIRS
Shannon Byler1, Alexandra Baker2, Eli Freiman2
1Boston Combined Residency Program, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States of America.
Insights
Common lab tests like CRP, ESR, lactic acid, and procalcitonin are specific but not sensitive for identifying severe sepsis in children with SIRS. These biomarkers can help identify severe sepsis but may miss some cases.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pathology
- Infectious Diseases
Background:
- Systemic inflammatory response syndrome (SIRS) is a common presentation in pediatric emergency departments.
- Early identification of severe sepsis is crucial for improving patient outcomes.
- Readily available laboratory biomarkers are often used to aid in sepsis diagnosis.
Purpose of the Study:
- To determine the association between common laboratory biomarkers and the development of severe sepsis in children with SIRS.
- To evaluate the sensitivity and specificity of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactic acid, and procalcitonin in predicting severe sepsis.
Main Methods:
- Retrospective cohort study analyzing emergency department encounters with sepsis alerts.
- Included patients with SIRS criteria and available CRP, ESR, lactic acid, or procalcitonin levels within 6 hours of arrival.
- Used receiver operating characteristic (ROC) curves to assess biomarker performance for severe sepsis and culture-positive sepsis.
Main Results:
- Procalcitonin showed the highest area under the curve (AUC) for severe sepsis (0.62).
- ESR (0.68) and CRP (0.67) had the highest AUC for culture-positive sepsis.
- At 90% sensitivity, biomarker thresholds were within normal ranges; at 90% specificity, thresholds were identified for each biomarker.
Conclusions:
- Elevated CRP, ESR, lactic acid, and procalcitonin are specific but not sensitive indicators for severe sepsis in pediatric SIRS patients.
- These biomarkers can aid in identifying severe sepsis but may not detect all cases, highlighting the need for clinical assessment.
Objective:
To identify the association between readily available laboratory biomarkers and the development of severe sepsis in children presenting to the emergency department (ED) with systemic inflammatory response syndrome (SIRS).
Methods:
In this retrospective cohort study, ED patient encounters from June 2018 to June 2019 that triggered an automated sepsis alert based on SIRS criteria were analyzed. Encounters were included if the patient had any of the following laboratory tests sent within 6 h of ED arrival: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactic acid, and procalcitonin. For each of the biomarkers, a receiver operating characteristic (ROC) curve was created for our primary outcome, severe sepsis within 24 h of ED disposition, and our secondary outcome, severe sepsis with a positive bacterial culture. For each ROC curve, we calculated the area under the curve (AUC) with 95% confidence intervals (95% CI) and created cutoff points to achieve 90% sensitivity and 90% sensitivity for the primary and secondary outcomes.
Results:
During the study period, 4349/61,195 (7.1%) encounters triggered an automated sepsis alert. Of those, 1207/4349 (27.8%) had one of the candidate biomarkers sent within 6 h of ED arrival and were included in the study. A total of 100/1207 (8.3%) met criteria for severe sepsis within 24 h of arrival, and 41/100 severe sepsis cases (41%) were deemed culture-positive. Procalcitonin had the highest AUC for identifying severe sepsis [0.62 (95% CI 0.52-0.73)] while ESR and CRP had the highest AUC for culture-positive sepsis [0.68 (95% CI 0.47-0.89) and 0.67 (95% CI 0.53-0.81), respectively]. At 90% sensitivity for detecting severe sepsis, all of the biomarker threshold values fell within that laboratory test's normal range. At 90% specificity for severe sepsis, threshold values were as follows: procalcitonin 2.72 ng/mL, CRP 16.79 mg/dL, ESR 79.5 mm/h and lactic acid 3.6 mmol/L.
Conclusion:
Our data indicate that CRP, ESR, lactic acid, and procalcitonin elevations were all specific, but not sensitive, in identifying children in the ED with SIRS who go on to develop severe sepsis.
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