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Early changes in procalcitonin and C-reactive protein during continuous renal replacement therapy and their

Kubra Boydag Guvenc1, Ebru Guney Sahin2, Sirin Guven3

  • 1Department of Pediatric Intensive Care, Health Science University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey. kubrabydg@gmail.com.

BMC Pediatrics
|July 15, 2026
PubMed

Insights

Continuous renal replacement therapy (CRRT) affects biomarker levels in critically ill children. Early procalcitonin (PCT) and C-reactive protein (CRP) kinetics showed limited ability to predict mortality, suggesting they are supportive, not standalone, prognostic tools.

Area of Science:

  • Pediatric Critical Care Medicine
  • Biomarker Kinetics
  • Renal Replacement Therapy

Background:

  • Continuous renal replacement therapy (CRRT) can alter biomarker levels in critically ill children.
  • Accurate interpretation of biomarkers like procalcitonin (PCT) and C-reactive protein (CRP) is challenging during CRRT.
  • Understanding early biomarker changes is crucial for prognostic assessment in pediatric intensive care.

Purpose of the Study:

  • To characterize the early kinetics of PCT and CRP within 24 hours of CRRT initiation in critically ill children.
  • To assess the association between early PCT and CRP levels and Pediatric Intensive Care Unit (PICU) mortality.
  • To evaluate the prognostic value of these biomarkers compared to established severity scores.

Main Methods:

  • Retrospective observational study of 152 critically ill pediatric patients undergoing CRRT.
  • Measurement of PCT and CRP levels at CRRT initiation (T0) and 24 hours post-initiation (T24).
  • Calculation of biomarker clearance, assessment of disease severity (PRISM-III, VIS), and logistic regression/ROC analysis for mortality prediction.

Main Results:

  • PICU mortality rate was 36.8%.
  • PCT levels were higher in non-survivors at T0 and T24, with significant decrease only in survivors. CRP showed no significant early changes.
  • PCT at T24 had modest discriminative ability for mortality (AUC=0.663), while CRP performed poorly. VIS and PRISM-III remained independent predictors.

Conclusions:

  • Early PCT and CRP kinetics within 24 hours of CRRT initiation have limited standalone prognostic value for pediatric critical care mortality.
  • While PCT at 24 hours showed some association with mortality in unadjusted analysis, its discriminatory performance was modest.
  • PCT and CRP should be interpreted as supportive biomarkers within the clinical context, not as replacements for established severity scores like PRISM-III and VIS.
Abstract

Keywords:
BiomarkersC-reactive proteinCRRTMortalityPediatric intensive careProcalcitoninSepsis

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