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Published on: April 18, 2011
Early changes in white blood cell, C-reactive protein and procalcitonin levels in children with severe multiple
Cai-Fang Xu1,2, Ming-Chao Huo1, Jin-Hui Huang1
1The Pediatrics Department, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Insights
In children with multiple trauma, early elevated white blood cells (WBC) and injury severity score (ISS) predict mortality better than procalcitonin (PCT). While PCT levels rose in most patients, WBC and ISS were more effective early indicators in the pediatric intensive care unit (PICU).
Area of Science:
- Pediatric critical care medicine
- Trauma research
- Biomarker analysis
Background:
- Assessing early inflammatory markers in pediatric multiple trauma is crucial for predicting outcomes.
- Investigating changes in white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT) before secondary inflammation is key.
Purpose of the Study:
- To analyze early changes in WBC, CRP, and PCT in pediatric multiple trauma patients.
- To determine the predictive value of these biomarkers for mortality in the pediatric intensive care unit (PICU).
Main Methods:
- Retrospective analysis of blunt traumatic injury patients in a single-center PICU.
- Division of patients into survival (n=141) and non-survival (n=36) groups based on 28-day outcomes.
- Receiver operating characteristic (ROC) curve analysis to evaluate biomarker predictive capacity for mortality.
Main Results:
- Elevated WBC, CRP, and PCT levels were observed in 81.36%, 31.07%, and 95.48% of patients, respectively.
- Non-survival group had significantly higher injury severity score (ISS) and WBC counts compared to the survival group.
- ROC analysis indicated ISS (AUC=0.799) and WBC (AUC=0.607) were significant predictors of 28-day mortality, while PCT (AUC=0.548) and CRP showed no significant predictive value.
Conclusions:
- Procalcitonin (PCT) levels increased in most pediatric multiple trauma patients, irrespective of WBC and CRP levels.
- Early elevation in white blood cells (WBC) and injury severity score (ISS) are superior predictors of mortality in pediatric trauma patients compared to PCT.
Background:
To analyze early changes in white blood cells (WBCs), C-reactive protein (CRP) and procalcitonin (PCT) in children with multiple trauma, before secondary inflammation develops.
Methods:
This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit (PICU). According to the prognostic outcome of 28 d after admission to the PICU, patients were divided into survival group (n=141) and non-survival group (n=36). Characteristics between the two groups were compared. Receiver operation characteristic (ROC) curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.
Results:
The percentages of children with elevated WBC, CRP, and PCT levels were 81.36%, 31.07%, and 95.48%, respectively. Patients in the non-survival group presented a statistically significantly higher injury severity score (ISS) than those in the survival group: 37.17±16.11 vs. 22.23±11.24 (t=6.47, P<0.01). WBCs were also higher in non-survival group than in the survival group ([18.70±8.42]×109/L vs. [15.89±6.98] ×109/L, t=2.065, P=0.040). There was no significant difference between the survival and non-survival groups in PCT or CRP. The areas under the ROC curves of PCT, WBC and ISS for predicting 28-day mortality were 0.548 (P=0.376), 0.607 (P=0.047) and 0.799 (P<0.01), respectively.
Conclusions:
Secondary to multiple trauma, PCT levels increased in more patients, even if their WBC and CRP levels remained unchanged. However, early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.
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