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Published on: December 9, 2022
Clinical Predictors and Biomarkers in Children With Sepsis and Bacterial Meningitis
Emanuele Castagno1, Sonia Aguzzi1, Lorenza Rossi2
1From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Insights
Procalcitonin levels and clinical signs like delayed capillary refill can predict poor outcomes in children with sepsis or meningitis. Early identification aids timely treatment and monitoring for better results.
Area of Science:
- Pediatric infectious diseases
- Clinical biomarkers
- Emergency medicine
Background:
- Sepsis and bacterial meningitis in children present with diverse clinical signs and inflammatory marker levels.
- Accurate prognostic tools are crucial for timely intervention in pediatric emergency departments (EDs).
Purpose of the Study:
- To evaluate the prognostic value of clinical features and biomarkers in children diagnosed with sepsis and bacterial meningitis in the ED.
- To identify early indicators of unfavorable outcomes, including short-term complications, long-term sequelae, and mortality.
Main Methods:
- A retrospective, observational study was conducted involving 194 children (0-14 years) admitted to a tertiary children's hospital's pediatric ED over 12 years.
- Data collected included epidemiological factors, early clinical signs, and laboratory tests, with a focus on procalcitonin levels at admission and 24 hours.
Main Results:
- Older age (>12 months), prolonged capillary refill time (>3 seconds), low oxygen saturation (<90%), and neurological signs were linked to adverse outcomes.
- Procalcitonin emerged as a key prognostic biomarker, with specific cut-off values identified for short-term complications, long-term sequelae, and mortality at admission and 24 hours.
Conclusions:
- Procalcitonin, combined with clinical assessment, is valuable for identifying high-risk pediatric patients with sepsis or meningitis.
- This approach facilitates optimized monitoring and treatment strategies to reduce morbidity and mortality.
Objectives:
Sepsis and meningitis in children may present with different clinical features and a wide range of values of inflammatory markers. The aim of this study was to identify the prognostic value of clinical features and biomarkers in children with sepsis and bacterial meningitis in the emergency department (ED).
Methods:
We carried out a single-center, retrospective, observational study on 194 children aged 0 to 14 years with sepsis and bacterial meningitis admitted to the pediatric ED of a tertiary children's hospital through 12 years.
Results:
Among epidemiological and early clinical features, age older than 12 months, capillary refill time greater than 3 seconds, and oxygen blood saturation lower than 90% were significantly associated with unfavorable outcomes, along with neurological signs ( P < 0.05). Among laboratory tests, only procalcitonin was an accurate and early prognostic biomarker for sepsis and bacterial meningitis in the ED, both on admission and after 24 hours. Procalcitonin cut-off value on admission for short-term complications was 19.6 ng/mL, whereas the cut-off values for long-term sequelae were 19.6 ng/mL on admission and 41.9 ng/mL after 24 hours, respectively. The cut-off values for mortality were 18.9 ng/mL on admission and 62.4 ng/mL at 24 hours.
Conclusions:
Procalcitonin, along with clinical evaluation, can guide the identification of children at higher risk of morbidity and mortality, allowing the most appropriate monitoring and treatment.
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