Background: The differentiation between systemic inflammatory response
syndrome (SIRS) and sepsis, which is sometimes difficult, is very
important as it determines essential treatment decisions, such as
selection, initiation, and duration of antibiotic therapy. Thus we aimed
to investigate the diagnostic value of procalcitonin (PCT), monocyte
chemoattractant protein-1 (MCP-1), soluble mannose receptor (sMR),
presepsin as early biomarkers of pediatric sepsis in comparison to SIRS
in a group of severely ill children. Methods: The study included 58 and
24 children diagnosed as having sepsis and SIRS without infection
respectively. All the plasma levels of the studied sepsis biomarkers
were measured and ROC curves were created for all the tested parameters
to discriminate between sepsis and SIRS. Results: The best
discriminative performance was for MCP-1 with AUC of 0.996 (0.986-1.005)
with sensitivity 98.3% and specificity 100%. The sMR had the highest
sensitivity (100%), with AUC equals 0.952(.0.887-1.017) and specificity
of 91.8%. The cut-off values for PCT, presepsin, sMR, and MCP-1 and
were: 2.1 ng/ml, 256 pg/ml, 24 ng/ml and 105 pg/ml, respectively. In
septic cases, both soluble Mannose Receptor and Procalcitonin have
positive correlations with the severity of sepsis (PRISM III), low GCS,
ventilatory support, use of inotropic drugs, and mortality rate (r=
0.950, 0.812, 0.795, 0.732 and 0.861respectively) for soluble Mannose
Receptor and (0.536, 0.473, 0.422, 0.305 and 0.474 respectively) for
Procalcitonin. By the logistic regression analysis, the sMR was the only
significant predictor of sepsis. Conclusion: The present study has found
that sMR, presepsin, and MCP-1 are new biomarkers that can be used to
differentiate between sepsis and SIRS in critically-ill children. These
findings may direct clinicians in their practical decision-making and
complex management of severely-ill children who need much interference
in short time.
