The Use of Procalcitonin as a Marker of Sepsis in Children

Abstract

Objective: Sepsis is a life-threatening disease which is associated with high rates of morbidity and mortality. The critically ill patients often manifest a Systemic Inflammatory Response Syndrome (SIRS) which is independent of an infection. The early diagnosis of different severities of sepsis is important for an early implementation of the specific therapies. Our objective was to evaluate the diagnostic and the prognostic values of blood Procalcitonin (PCT) in cases of bacterial septicaemia in children. Methods:The total sample comprised of 150 subjects who were admitted to the ICU with septicaemia and 50 normal, healthy, age and sex matched children. The first sample was collected at the time of admission, before the start of the antibiotic therapy (T0). A second sample was collected at 24 hours (T24) and a final sample was collected at 96 hours (T96). A PCT value of > 0.5ng/ml was accepted as positive.Results: 63% of the children who were diagnosed with a bacterial aetiology showed detectable blood PCT levels with higher concentrations, while in the children who were diagnosed with a viral aetiology, only 22.2 % had detectable PCT levels, but in lower concentrations. The mean percentage reduction in the PCT value among the bacterial infection subjects was 44.39 ± 41.82 as compared to that in the viral infection subjects (5.71 ± 26.68) and in the subjects where the aetiology was not established (5.71 ± 26.68). Conclusion:The results which were obtained in our study confirmed that the PCT levels were a better marker for the bacterial infections. The PCT measurements may be used as a guide to the antibiotic therapy in critically ill children with suspected sepsis.

Update on Procalcitonin Measurements

“…The common link between PCT elevation and bacterial infection is the severity of systemic inflammatory response. Bacterial infection is a strong stimulus for PCT production whereas if the systemic inflammation is due to viral infection, the PCT induction is low [ 28 , 29 , 30 , 31 ]. Also in patients with SIRS, there may be PCT induction, but this is usually not as high as in severe sepsis.…”

Machine Learning Approaches for Discriminating Bacterial and Viral Targeted Human Proteins

“…Widely used parameters such as WBC counts and C-reactive protein (CRP), may aid to differentiate between bacterial and viral infections, but lack sensitivity and specificity, leading to frequent misdiagnosis. Newer bacterial infection markers, such as presepsin, procalcitonin, and CD64, are used for severe sepsis, while proADM may predict prognosis of the disease [35,36]. In contrast, cytokines, such as IL-2, IL-8, and IL-10 were suggested as early biomarkers for viral infection [37].…”

Clinical and Cost-Effectiveness of Procalcitonin Test for Prodromal Meningococcal Disease–A Meta-Analysis

“…In the case of early MD detection, it is desirable for a test to have high test sensitivity to reduce the chance of a missed diagnosis of potentially fatal MD. Many have demonstrated the PCT test to be more accurate for predicting invasive bacterial infections [ 36 – 45 ] sepsis [ 46 , 47 ] and so ruling-out serious bacterial infection [ 28 , 48 – 50 ]. Within these past studies, a range of diagnostic thresholds has been used for the PCT test.…”