Association between serum procalcitonin levels and outcomes of patients admitted to two tertiary paediatric intensive care units in Bloemfontein: A retrospective analytical study
Article Sidebar
Main Article Content
Abstract
Background. Procalcitonin (PCT) is used in the diagnosis of sepsis. Its capability as a prognostic marker is unclear. The association between PCT and paediatric intensive care unit (PICU) outcomes has not been investigated in the South African setting.
Objectives. To determine the association between admission PCT, and trends within 72 hours of admission, and outcomes of patients admitted to the PICU at two tertiary academic hospitals.
Methods. The study was a two-year, double centre, retrospective, analytical cross-sectional medical record review.
Results. A total of 381 participants were included in the study; 55 died and 220 required mechanical ventilation. Non-survivors had a higher median admission PCT than survivors (p<0.0001, 95% confidence interval (CI) 1.28 - 15.12). Non-survivors had a higher median PCT at 48 - 72 hours than survivors (p<0.0001, 95% CI 2.50 - 21.72). Non-survivors had less of a median decrease in PCT than survivors (p=0.22, 95% CI -0.59 - 4.72). The area under the receiver operating characteristics curve (AUROCC) for admission PCT to discriminate for mortality was 0.6702 and for the 48 - 72 hour PCT it was 0.7369. There was a positive correlation between PCT and number of ventilator days (Spearman correlation co-efficient =0.1477, p=0.0138). There was no correlation between the length of PICU stay and admission PCT (p=0.7579) or PCT change (p=0.2034).
Conclusion. Single PCT measurements display some ability to discriminate for PICU mortality. Serial PCT measurements provide greater prognostic information. Non-survivors had a significantly greater median admission PCT, median PCT at 48 - 72 hours and a lower median PCT decrease than survivors.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright and grant the journal right of first publication.
How to Cite
References
1. Aygun F. Procalcitonin value is an early prognostic factor related to mortality in admission to pediatric intensive care unit. Crit Care Res Pract 2018;2018:9238947.
2. Siddiqui I, Jafri L, Abbas Q, Raheem A, Haque AU. Relationship of serum procalcitonin, c-reactive protein, and lactic acid to organ failure and outcome in critically ill pediatric population. Indian J Crit Care Med 2018;22(2):91-95.
3. Pudjiadi AH, Yanti M, Tumbelaka AR. Prognostic factors of death in children admitted to pediatric intensive care unit, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Paediatr Indones [Internet]. 2002 [cited 25 June 2019];42(11):254-260. https://paediatricaindonesiana.org/ index.php/paediatrica-indonesiana/article/view/1035
4. Poddar B, Gurjar M, Singh S, Aggarwal A, Baronia A. Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock—a pilot study. J Crit Care 2016;36:230-233.
5. Bobillo-Perez S, Rodríguez-Fanjul J, Jordan Garcia I. Is procalcitonin useful in pediatric critical care patients? Vol. 13, Biomarker Insights. 2018.
6. Hatherill M, Tibby SM, Turner C, Ratnavel N, Murdoch IA. 2000. Procalcitonin and cytokine levels: Relationship to organ failure and mortality in pediatric septic shock. Crit Care Med 28:2591-2594. htpps://doi.org/10.1097/00003246-200007000-00068.
7. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020;21(2):e52-e106.
8. Ramasawmy D, Pillay M, Hardcastle TC. Correlation of procalcitonin to positive blood culture results in a sample of South African trauma ICU patients between 2016 and 2017. Eur J Trauma Emerg Surg 2020;47(4):1183-1188.
9. Naidoo K, De Vasconcellos K, Skinner DL. Procalcitonin kinetics in the first 48 hours of ICU admission is associated with higher mortality in critically ill patients with community-acquired pneumonia in a setting of high HIV prevalence. South African J Anaesth Analg 2018;24(5):128-134.
10. Downes KJ, Weiss SL, Gerber JS, et al. A pragmatic biomarker-driven algorithm to guide antibiotic use in the pediatric intensive care unit: The optimizing antibiotic strategies in sepsis (OASIS) study. J Pediatric Infect Dis Soc 2017;6(2):134-141.
11. Meng FS, Su L, Tang YQ, Wen Q, Liu YS, Liu ZF. Serum procalcitonin at the time of admission to the ICU as a predictor of short-term mortality. Clin Biochem 2009;42(10-11):1025-1031.
12. Baranwal A, Singh V, Muralidharan J, Sachdeva N. Serial procalcitonin correlated well with organ dysfunction and outcome of pediatric septic shock. Crit Care Med 2019;47:809. http://journals. lww.com/00003246-201901001-01620
13. Ryoo SM, Han KS, Ahn S, et al. The usefulness of C-reactive protein and procalcitonin to predict prognosis in septic shock patients: A multicenter prospective registry-based observational study. Sci Rep 2019;9(1).
14. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. Vol. 95, Journal of Biomedical Informatics. 2019.
15. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture
(REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377-381.