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Procalcitonin-to-Albumin Ratio vs. C-reactive Protein-to-Albumin Ratio in Predicting Sepsis and Its Severity in
Vetsa Snigdha Hasa1, Bandya Sahoo2, Mukesh K Jain2
1Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Insights
The procalcitonin-to-albumin ratio (PAR) is a more specific marker than the C-reactive protein-to-albumin ratio (CAR) for diagnosing pediatric sepsis. Both ratios show moderate accuracy, but PAR is better at identifying severe cases.
Area of Science:
- Pediatric critical care medicine
- Biomarker research
- Infectious diseases
Background:
- Sepsis is a leading cause of child mortality and morbidity.
- Early and accurate diagnosis is crucial for effective treatment.
- Novel biomarkers are needed to improve sepsis detection and management in children.
Purpose of the Study:
- To compare the diagnostic performance of the procalcitonin-to-albumin ratio (PAR) and C-reactive protein-to-albumin ratio (CAR) in pediatric sepsis.
- To determine which ratio is superior in predicting sepsis and its severity in children.
Main Methods:
- Prospective observational study of 118 children with suspected sepsis.
- Measurement of procalcitonin, CRP, and albumin on days 0, 2, and 7 of admission.
- Analysis of diagnostic accuracy using Receiver Operating Characteristic (ROC) curves.
Main Results:
- PAR exhibited high specificity (95.61%) for sepsis prediction on admission, while CAR showed higher sensitivity (67.36%).
- Area Under the Curve (AUC) for PAR was 0.73, and for CAR was 0.67, indicating moderate diagnostic accuracy for both.
- Sepsis severity indicators included septic shock (19%), MODS (9%), and death (11%).
Conclusions:
- Both PAR and CAR are valuable for diagnosing pediatric sepsis and its severity.
- PAR is a more reliable marker for ruling in sepsis due to its higher specificity.
- PAR and CAR can complement existing markers, with PAR potentially aiding in identifying severe cases.
Background:
Sepsis is one of the leading causes of morbidity and mortality in children. The aim of our study was to compare the procalcitonin-to-albumin ratio (PAR) and C-reactive protein(CRP)-to-albumin ratio (CAR) in predicting sepsis and its severity in children and to know which one is better.
Methods:
This prospective observational study was conducted in a tertiary care hospital from July 2022 to January 2024. Procalcitonin, CRP, and albumin, along with baseline investigations, were sent on the day of admission (day 0), day 2 of admission, and day 7 of admission for all the children with suspected sepsis.
Results:
This study included 118 children diagnosed with sepsis who were analyzed. Among them, 83 (70%) were male. The median age was 11 years, with a range of two months to 17 years. The median duration of fever prior to hospitalization was four days. The mortality and morbidity distribution included total septic shock in 22 (19%), multiple organ dysfunction (MODS) in 12 (9%), and death in 13 (11%). In total, 22 (19 %) patients required inotropic support, and 15 (13 %) required respiratory support. The cut-off value for predicting sepsis obtained for PAR was 13.5 with sensitivity 49.47% and specificity 95.61% on the day of admission, whereas the cut-off value for CAR was 0.31 with sensitivity 67.36% and specificity 64.21% on the day of admission. Receiver-operating characteristic (ROC) curve analysis was done for the diagnostic value of PAR and CAR, and the area under the curve (AUC) for detecting sepsis were 0.73 (95%CI=0.634-0.827) and 0.67 (95% CI=0.544-0.796), respectively.
Conclusion:
The study demonstrates that the PAR and CAR are valuable diagnostic markers for predicting sepsis in children. On the day of admission, PAR showed a higher specificity (95.61%) compared to CAR (64.21%), making it a reliable marker for ruling in sepsis, while CAR exhibited greater sensitivity (67.36%) for detecting cases. The ROC curve analysis revealed AUC values of 0.73 for PAR and 0.67 for CAR, indicating moderate diagnostic accuracy for both. These findings suggest that PAR and CAR can complement traditional markers in diagnosing pediatric sepsis and its severity, with PAR being particularly useful in identifying more severe cases. Further research is warranted to validate these markers and explore their prognostic utility over time.
