1Mohamed I Abdel–Hamid, 1Ahmed M. Amin, 2Mostafa Abo–Farrag, 2Hamid El – Sharkawy, 2Amr Zoair, 2Ahmed Abdel Razik
1Microbiology and 2Pediatric Departments,
Faculty of Medicine, Tanta University, Tanta, Egypt.
The study was designed to
validate the usefulness of admission serum procalcitonin (PCT), as an early
reliable diagnostic marker of sepsis in critically-ill children with systemic
inflammatory response syndrome (SIRS) in comparison with pro-inflammatory
cytokine interleukin-6 (IL-6), serum lactate, total leucocytic count (TLC), and
C-reactive proteins (CRP). The study is a prospective observational study. From
Pediatric intensive care unit of Tanta University Hospital. A total of 59
children with SIRS, having a median age of 61.3 months. They included 37 males
and 22 females. Children who had received antibiotics for > 24 hrs were
excluded. A total of 19 patients (32.2%) had non-infectious SIRS and 40
patients (67.8%) had infectious SIRS. Patients with infectious SIRS were
subdivided into three groups according to the severity of sepsis; uncomplicated
sepsis (n = 10); sepsis syndrome (n=21) and septic shock (n=9). The admission
pediatric risk of mortality (PRISM) score, admission multiple organ system
failure (MOSF) score, and ultimate outcome were recorded. Serum PCT, serum
IL-6, serum lactate, TLC, CRP were measured at admission to the intensive care
unit for all patients. Second day laboratory data were obtained for patients
who experienced severe SIRS by day 2 (36 patients). The observed mortality was
10/59 (17%). The admission PCT was shown to be the most reliable marker for the
early differentiation of infectious vs. non-infectious SIRS (P<0.05),
whereas admission IL-6, lactate, TLC, and C-RP were shown to be insignificant
markers for early differentiation of infectious vs. non-infectious SIRS
(P>0.05). Furthermore, higher admission serum concentrations of PCT
correlated significantly with sepsis severity (P<0.05) but insignificantly
associated with non-survival (P>0.05). On the other hand, persistent
elevation of PCT level despite 24 hrs of ongoing antibiotic therapy and
intensive care was found to be significantly associated with increased
mortality (P<0.001). In conclusion: i) Admission PCT is
suggested to be a reliable indicator of sepsis in critically-ill children with
SIRS. ii) serial PCT assay might be of value in predicting the outcome and in
monitoring the response to treatment in children with severe infectious SIRS. iii) The current data add to a growing body of evidence that PCT release
may be harmful in critically ill children with sepsis. These data highlight the
great need to develop “anti-PCT” therapies that might prove more efficacious
than other anti-cytokine treatment modalities in such children.