Procalcitonin and C-reactive protein: Comparison of two markers for sepsis-syndrom in severely immunocompromised children offer bone marrow transplantation

Background: PCT has recently drawn attention as a quite specific marker for bacterial, fungal, and parasitic origin of severe sepsis-syndrome. These s pecific properties could make PCT to an important tool for sepsis monitorin g in severely immunocompromised children. The clinical value of PCT in comp arison to CrP was investigated in children after bone marrow transplantatio n (BMT). Methods: PCT was measured in the serum of 48 children (median age 12.4 years) after BMT in a prospective study. Results were correlated with the clinical findings and compared to the C-reactive protein (CrP). Results : PCT showed a sensitivity for diagnosing a sepsis-syndrome of 56 %, a spec ifity of 87 %, a positive predictive value of 69 %, and a negative predicti ve value of 80 %. Regarding CrP they were 100 %, 41 %, 46 % and 100 % respe ctively. The relative risk to die due to sepsis-syndrome was 26.4 for PCT l evels over 10 ng/ml and 4.0 for CrP levels over 200 mg/l. It could be shown furthermore that there can be a significant liberation of PCT even during hematological aplasia. Conclusion: (1) Measuring PCT levels in the sera of children undergoing BMT improves the possibility of diagnosing severe infec tion and gives an important prognostic tool. (2) Measuring PCT can be recom mended if severe sepsis-syndrome is suspected and there is an additional ne ed for differential diagnosis and prognostic evaluation.