Diagnostic Challenges and Laboratory Considerations for Pediatric Sepsis

Abstract

Background Sepsis is a leading cause of death for children in the US and worldwide. There is a lack of consensus how sepsis is clinically defined, and sepsis definitions and diagnostic guidelines for the pediatric population have remained unchanged for more than a decade now. Current pediatric definitions are largely based on adult guidelines and expert opinion rather than evidence based on outcomes in the pediatric populations. Without a clear definition of sepsis, it is challenging to evaluate the performance of new laboratory tests on the diagnosis and management of sepsis. Content This review provides an overview of common etiologies of sepsis in pediatric populations, challenges in defining and diagnosing pediatric sepsis, and current laboratory tests used to identify and monitor sepsis. Strengths and limitations of emerging diagnostic strategies will also be discussed. Summary Currently there is no single biomarker that can accurately diagnose or predict sepsis. Current biomarkers such as C-reactive protein and lactate are neither sensitive nor specific for diagnosing sepsis. New biomarkers and rapid pathogen identification assays are much needed. Procalcitonin, although having some limitations, has emerged as a biomarker with demonstrated utility in management of sepsis in adults. Parallel studies analyzing the utility of procalcitonin in pediatric populations are lagging but have shown potential to affect sepsis care in pediatric populations. Multibiomarker approaches and stepwise algorithms show promise in the management of pediatric sepsis. However, a major hurdle is the lack of validated clinical criteria for classification of pediatric sepsis, which is necessary for the development of well-designed studies that can assess the clinical impact of these emerging biomarkers.

Metabolic responses in neonatal sepsis—A systematic review of human metabolomic studies

“…Additionally, serial measurements may be useful in monitoring treatment, but lactate concentrations often do not increase until late in the sepsis continuum. 28 In our systematic review, lactate was increased in the sepsis group in three studies, 17,18,20 but not in the single fungal sepsis case, described by Dessì et al 19 Our finding is in line with reports showing that aerobic glycolysis sustains the energy requirements for the activated immune cells. 29,30 Recently, this process has also been shown to alter the metabolism in a way that promotes changes in the immune cell's phenotype.…”

“…In children and neonates, lactate is neither sensitive nor specific for diagnosing sepsis, but mainly used to determine sepsis severity and as an indicator of organ dysfunction in patients with septic shock. Additionally, serial measurements may be useful in monitoring treatment, but lactate concentrations often do not increase until late in the sepsis continuum 28 . In our systematic review, lactate was increased in the sepsis group in three studies, 17,18,20 but not in the single fungal sepsis case, described by Dessì et al 19 .…”

Relationship Between Resistin Levels and Sepsis Among Children Under 12 Years of Age: A Case Control Study

“…According to the findings of a 2009 German study by Koch (37), resistin serum concentrations were significantly higher in sepsis than in non-sepsis patients hospitalized in ICU. Findings of another study by Aliefendioglu on premature newborns in NICU (38) was in line with the results of the present study.…”

Korelasi Positif antara Neutrophil Lymphocyte Count Ratio dan C-Reactive Protein pada Pasien Sepsis Anak

“…Kultur darah merupakan baku emas untuk diagnosis sepsis, tetapi perlu waktu lama dan fasilitas tersebut tidak semua dimiliki rumah sakit sehingga aplikasi di lapangannya sulit. 6 Pada pasien sepsis, telah diteliti berbagai parameter dan sistem penilaian atau skoring guna menegakkan diagnosis, memperkirakan prognosis, serta menilai/memantau perbaikan dan juga perburukan pasien. 6,7,8 Neutrophil-lymphocyte count ratio (NLCR) merupakan salah satu parameter yang dapat digunakan sebagai tolak ukur inflamasi sistemik, mudah untuk dihitung, dan tersedia dari panel pemeriksaan darah rutin pasien.…”

“…6 Pada pasien sepsis, telah diteliti berbagai parameter dan sistem penilaian atau skoring guna menegakkan diagnosis, memperkirakan prognosis, serta menilai/memantau perbaikan dan juga perburukan pasien. 6,7,8 Neutrophil-lymphocyte count ratio (NLCR) merupakan salah satu parameter yang dapat digunakan sebagai tolak ukur inflamasi sistemik, mudah untuk dihitung, dan tersedia dari panel pemeriksaan darah rutin pasien. 9 Neutrophil-lymphocyte count ratio didapatkan dari hasil pembagian jumlah neutrofil absolut dengan jumlah limfosit absolut.…”