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VOLUME 22 , ISSUE 2 ( 2018 ) > List of Articles

RESEARCH ARTICLE

Relationship of Serum Procalcitonin, C-reactive Protein, and Lactic Acid to Organ Failure and Outcome in Critically Ill Pediatric Population

Qalab Abbas, Ahmed Raheem, Anwar Ul Haque

Keywords : Critical care, death, intensive care units, procalcitonin, prognosis, sepsis

Citation Information : 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.

DOI: 10.4103/ijccm.IJCCM_4_17

License: CC BY-ND 3.0

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Objective: To evaluate the clinical and prognostic utility of procalcitonin (PCT), C-reactive protein (CRP), and lactic acid in children admitted to the Pediatric Intensive Care Unit (PICU) of a university teaching hospital. Materials and Methods: Medical records of children (1 month–16 years) tested for serum PCT at the time of admission in the PICU of our hospital from July 1, 2013, to January 15, 2015, were reviewed. Within 24 h of admission, the Pediatric Risk of Mortality Score, blood cultures, white blood cell count, neutrophil counts, serum CRP, plasma lactic acid, and PCT were noted. Patient outcome was assessed at hospital discharge, and the patients were divided into nonsurvivors and survivors. Results: A total of 167 children being admitted to the PICU were enrolled. The median age of the study population was 3 years (0–16 years), with 58.6% being males. Nonsurvivors had significantly higher lactic acid (4.7 mmol/L [2.07–7.6]; P < 0.05) than that of the survivors (2 mmol/L [1.3–3]; P < 0.05). In addition, nonsurvivors (94.4%; P < 0.05) had greater incidence of multiple organ dysfunction syndrome (MODS) than that of the survivors (38.05%; P < 0.05). Binary logistic regression showed age, MODS, and lactic acid to be associated with mortality. Conclusions: This study found that in comparison to PCT and CRP, high plasma lactic acid levels are associated with the development of all-cause MODS and worse outcome in critically ill children admitted in PICU. Prediction of prognosis based on the lactic acid alone may contribute to improve patient management, but further studies are required to endorse our findings.


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  1. Lin YJ. The changing characteristics of neonatal sepsis in the neonatal Intensive Care Unit: A never-ending challenge. Pediatr Neonatol 2009;50:83-4.
  2. Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L. Diagnosis of neonatal sepsis: A clinical and laboratory challenge. Clin Chem 2004;50:279-87.
  3. Randolph AG, McCulloh RJ. Pediatric sepsis: Important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence 2014;5:179-89.
  4. Shin YJ, Ki M, Foxman B. Epidemiology of neonatal sepsis in South Korea. Pediatr Int 2009;51:225-32.
  5. Engel C, Brunkhorst FM, Bone HG, Brunkhorst R, Gerlach H, Grond S,et al. Epidemiology of sepsis in Germany: Results from a national prospective multicenter study. Intensive Care Med 2007;33:606-18.
  6. Bhutta ZA, Naqvi SH, Muzaffar T, Farooqui BJ. Neonatal sepsis in Pakistan. Presentation and pathogens. Acta Paediatr Scand 1991;80:596-601.
  7. Rahman S, Hameed A, Roghani MT, Ullah Z. Multidrug resistant neonatal sepsis in Peshawar, Pakistan. Arch Dis Child Fetal Neonatal Ed 2002;87:F52-4.
  8. Branco RG, Garcia PC, Garcia JP, Piva JP, Ross-Russell R. Interactions of sepsis, organ dysfunction, and outcome of critically ill children. Am J Respir Crit Care Med 2005;172:1606.
  9. Martinot A, Leclerc F, Cremer R, Leteurtre S, Fourier C, Hue V,et al. Sepsis in neonates and children: Definitions, epidemiology, and outcome. Pediatr Emerg Care 1997;13:277-81.
  10. Dunne WM Jr. Laboratory diagnosis of sepsis? No SIRS, not just yet. J Clin Microbiol 2015;53:2404-9.
  11. Sharma D, Farahbakhsh N, Shastri S, Sharma P. Biomarkers for diagnosis of neonatal sepsis: A literature review. J Matern Fetal Neonatal Med. 2017 May 7:1-14. [Epub ahead of print].
  12. Yan HP, Lu XL, Qiu J, Liu PP, Zuo C, Zhu YM,et al. Value of blood lactic acid in evaluating disease severity and prognosis in children with sepsis. Zhongguo Dang Dai Er Ke Za Zhi 2016;18:506-10.
  13. Mikić D, Arsić-Komljenović G, Nozić D, Cućuz M, Dimitrijević R, Vukadinov J,et al. Blood concentrations of lactate, C-reactive protein, and creatinine as early indicators of severity and outcome of sepsis. Med Pregl 2010;63:267-73.
  14. Shabuj KH, Hossain J, Moni SC, Dey SK. C-reactive protein (CRP) as a single biomarker for diagnosis of neonatal sepsis: A Comprehensive meta-analysis. Mymensingh Med J 2017;26:364-71.
  15. Hisamuddin E, Hisam A, Wahid S, Raza G. Validity of C-reactive protein (CRP) for diagnosis of neonatal sepsis. Pak J Med Sci 2015;31:527-31.
  16. Becker KL, Nylén ES, White JC, Müller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: A journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89:1512-25.
  17. Elbirt D, Frenkel Rubin M, Ergaz D, Sthoeger Z. Procalcitonin – A specific marker for severe bacterial infection and sepsis. Harefuah 2001;140:343-6.
  18. Enguix A, Rey C, Concha A, Medina A, Coto D, Diéguez MA,et al. Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children. Intensive Care Med 2001;27:211-5.
  19. Han YY, Doughty LA, Kofos D, Sasser H, Carcillo JA. Procalcitonin is persistently increased among children with poor outcome from bacterial sepsis. Pediatr Crit Care Med 2003;4:21-5.
  20. Harrison M, Collins CD. Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial infection and sepsis? Infect Control Hosp Epidemiol 2015;36:265-72.
  21. Westwood M, Ramaekers B, Whiting P, Tomini F, Joore M, Armstrong N,et al. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: A systematic review and cost-effectiveness analysis. Health Technol Assess 2015;19:v-xxv, 1-236.
  22. Sauer M, Tiede K, Fuchs D, Gruhn B, Berger D, Zintl F,et al. Procalcitonin, C-reactive protein, and endotoxin after bone marrow transplantation: Identification of children at high risk of morbidity and mortality from sepsis. Bone Marrow Transplant 2003;31:1137-42.
  23. Rey C, García-Hernández I, Concha A, Martínez-Camblor P, Botrán M, Medina A,et al. Pro-adrenomedullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: A prospective study. Crit Care 2013;17:R240.
  24. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
  25. Giamarellos-Bourboulis EJ, Tsangaris I, Kanni T, Mouktaroudi M, Pantelidou I, Adamis G,et al. Procalcitonin as an early indicator of outcome in sepsis: A prospective observational study. J Hosp Infect 2011;77:58-63.
  26. Liu X, Wang DF, Fang Y, Ye WF, Liu S, Lou N,et al. Initial procalcitonin level predicts infection and its outcome in patients with non-Hodgkin lymphoma with febrile neutropenia. Leuk Lymphoma 2015;56:85-91.
  27. Wang C, Gao L, Zhang ZG, Li YQ, Yang YL, Chang T,et al. Procalcitonin is a stronger predictor of long-term functional outcome and mortality than high-sensitivity C-reactive protein in patients with ischemic stroke. Mol Neurobiol 2016;53:1509-17.
  28. Bartolovic D, Ignjatovic S, Stankovic S, Nada Majkić S. Procalcitonin and other biomarkers of sepsis in newborns in the Intensive Care Unit. EJIFCC 2011;22:24-30.
  29. Dahaba AA, Hagara B, Fall A, Rehak PH, List WF, Metzler H,et al. Procalcitonin for early prediction of survival outcome in postoperative critically ill patients with severe sepsis. Br J Anaesth 2006;97:503-8.
  30. Meng FS, Su L, Tang YQ, Wen Q, Liu YS, Liu ZF,et al. Serum procalcitonin at the time of admission to the ICU as a predictor of short-term mortality. Clin Biochem 2009;42:1025-31.
  31. Bustos BR, Padilla PO. Predictive value of procalcitonin in children with suspected sepsis. Rev Chil Pediatr 2015;86:331-6.
  32. Magrini L, Travaglino F, Marino R, Ferri E, De Berardinis B, Cardelli P,et al. Procalcitonin variations after emergency department admission are highly predictive of hospital mortality in patients with acute infectious diseases. Eur Rev Med Pharmacol Sci 2013;17 Suppl 1:133-42.
  33. Casado-Flores J, Blanco-Quirós A, Nieto M, Asensio J, Fernández C. Prognostic utility of the semi-quantitative procalcitonin test, neutrophil count and C-reactive protein in meningococcal infection in children. Eur J Pediatr 2006;165:26-9.
  34. Scott HF, Donoghue AJ, Gaieski DF, Marchese RF, Mistry RD. The utility of early lactate testing in undifferentiated pediatric systemic inflammatory response syndrome. Acad Emerg Med 2012;19:1276-80.
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