DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20190037

Study of serum levels of CRP and procalcitonin as early marker of sepsis in children with sepsis above neonatal age group

Vinaya Kumar, Ramesh Neelannavar

Abstract


Background: Sepsis caused by infection remains a major cause of mortality and morbidity among children.  Blood culture though gold standard requires lot of time for diagnosis, hence it’s necessary to rely on early diagnostic markers such as blood counts, micro-ESR, CRP, Procalcitonin. The objective of this study is to evaluate the serum levels of CRP, Procalcitonin as reliable and as early marker of sepsis in pediatric patients above neonatal age group.

Methods: Children aged above neonatal age group with clinically suspected sepsis as per the definition given by the International Paediatric sepsis Consensus Conference were selected. Patients were classified as those with sirs, sepsis, severe sepsis and septic shock. Patients were divided into two groups one with culture proven sepsis and the other with non-culture proven sepsis. All patients had CRP, Procalcitonin levels measured at admission and 24hrs after admission. The primary outcome was to determine reliable marker in differentiating between the culture proven and non-culture proven sepsis, and to determine the early marker of sepsis.

Results: Total 104 patients formed the study group, of which 42 belonged to SIRS group, 26 were sepsis, 19 were severe sepsis and 17 were septic shock. A total of 36 cases had culture positive. In present study PCT was found to be more reliable marker of sepsis as the sensitivity and specificity of PCT was more than CRP and AUC for PCT was significantly higher than CRP. PCT was found to be early marker as the AUC for CRP at 24hrs was significantly more than AUC for CRP at admission and there was no statistically significant difference between AUC for PCT at admission and 24 hours after admission.

Conclusions: Both CRP and PCT levels have favourable test performance but PCT is more reliable. PCT is earlier to rise compared to CRP.


Keywords


C-reactive protein, Early marker, Paediatric sepsis, Procalcitonin, Reliable marker

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References


Proulx F, Fayon M, Farrell CA, Lacroix J, Gauthier M. Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest. 1996;109(4):1033-7.

Watson RS, Carcillo JA. Scope and epidemiology of pediatric sepsis. Pediatr Critical Care Med. 2005;6(3):S3-5.

Randolph AG. The purpose of the 1st International sepsis forum on sepsis in infants and children. Pediatr Critical Care Med. 2005;6(3):S1-2.

Brilli RJ, Goldstein B. Pediatric sepsis definitions: past, present, and future. Pediatr Critical Care Med. 2005;6(3):S6-8.

Mishra UK, Jacobs SE, Doyle LW, Garland SM. Newer approaches to the diagnosis of early onset neonatal sepsis. Arch Dis Childhood-Fetal Neonatal Edit. 2006;91(3):F208-12.

Hugonnet S, Sax H, Eggimann P. Nosocomial blood stream infection and clinical sepsis. Emerg Infect Dis. 2004;10:76-81.

Guven H, Altintop L, Baydin A, Esen S, Aygun D, Hokelek M, et al. Diagnostic value of procalcitonin levels as an early indicator of sepsis. Am J Emergency Med. 2002;20(3):202-6.

Casado-Flores J, Blanco - Quiros A, Asesnsio J, Arranz E, Garrote J, Nieto M. Serum procalcitonin in children with suspected sepsis. A comparison with C reactive protein and neutrophil count. Pediatr Crit Care Med. 2003;4:190-5.

Hathrill M, Tibby SM, Sykes K, Turner C, Murdoch IA. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child. 1999;81:417-21.

Goldstein B, Giroir B, Randolph A. the members of the International Consensus Conference on Pediatric Sepsis. InInternational pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6(1):2-8.

Galetto-Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatr. 2003;112(5):1054-60.

Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clinic Infect Dis. 2004;39(2):206-17.

Suprin E, Camus C, Gacouin A, Le Tulzo Y, Lavoue S, Feuillu A, et al. Procalcitonin: a valuable indicator of infection in a medical ICU?. Intensive Care Med. 2000;26:1232-8.

Simon L, Saint-Louis P, Amre DK, Lacroix J, Gauvin F. Procalcitonin and C-reactive protein as markers of bacterial infection in critically ill children at onset of systemic inflammatory response syndrome. Pediatr Critical Care Med. 2008;9(4):407-13.

Pavare J, Grope I, Eihvalde L, Gardovska D. Diagnostic markers for identifying sepsis in patients with systemic inflammatory response syndrome (SIRS): A prospective study. Open Pediatr Med J. 2009;3:1-7.