Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children
A. Enguix 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, INTEN CAR M, 27(1), 2001, pp. 211-215
Objectives: To evaluate procalcitonin (PCT) as a diagnostic marker of bacte
rial sepsis in critically ill neonates and children and to compare the resu
lts of PCT with those of C-reactive protein (CRP) and serum amyloid (SAA).
Design and setting: Prospective, observational study in neonatal and pediat
ric intensive care units.
Patients: A total of 116 divided into four groups according to age and diag
nosis: neonates (aged 3-30 days) with sepsis (n = 20), neonates without sep
sis (n = 26), children (aged 2-12 years) with sepsis (n = 32), and children
without sepsis (n = 38).
Interventions: Serum PCT, CRP, and SAA were measured on admission or when a
bacterial sepsis was suspected. Area under the receiver operating characte
ristic (ROC) curve, optimum predictive values, and optimum diagnostic cut o
ff values were evaluated.
Results: Admission PCT was significantly higher in neonates and children wi
th sepsis than in the other groups. In the neonates the area under the ROC
curve was 0.99 for PCT, 0.95 for CRP, and 0.98 for SAA; in the children it
was 1 for PCT, 0.93 for CRP, and 0.96 for SAA. Cutoff concentrations for op
timum prediction of sepsis in the neonates were PCT > 6.1 ng/ml (diagnostic
efficiency: 93.8%), CRP > 23.0 mg/l (89.7%), and SAA > 41.3 mg/l (95.3%);
in the children they were PCT > 8.1 ng/ml (100%), CRP > 22.1 mg/l (89.8%),
and SAA > 67.2 mg/l (94.4%).
Conclusion: In critically ill children PCT concentration is a better diagno
stic marker of sepsis than CRP and SAA. In critically ill neonates, however
, PCT, CRP, and SAA are similar diagnostic markers of sepsis. A PCT concent
ration higher than 8.1 ng/ml identified all children with bacterial sepsis.