Procalcitonin in paediatric sepsis

Objective

To document the relationships between procalcitonin (PCT), C-reactive protein (CRP) and leucocyte count (WCC) in children with sepsis, and to compare their diagnostic value in septic shock.

Methods

PCT, CRP and WCC were measured on admission to the PICU in 146 children, median age 18 months (range 0.1-202), mortality 22/146 (15%). PCT was measured by immunoluminometric assay (BRAHMS Diagnostika, Berlin, Germany). Patients were categorized a priori according to clinical and laboratory data as having either septic shock (n = 51) [1], localized bacterial infection (n = 33), viral infection (n = 14) or as non-infected controls (n = 48). Data were analysed by Kruskal-Wallis ANOVA and Dunn's test for multiple comparisons.

Results

PCT was significantly higher in septic patients compared to localized infection, viral infection and controls respectively (all P < 0.001). Receiver operating curve analysis indicates PCT > 20 ng/ml as the best discriminator of septic shock with positive and negative predictive values of 87% and 89%. In contrast, CRP > 35 mg/l had positive and negative predictive values of 65% and 83%.

Conclusion

Procalcitonin is a better discriminator of systemic from localized bacterial infection than either CRP or leucocyte count.

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