Modeling effect of the septic condition and trauma on C-reactive protein levels in children with sepsis: a retrospective study

Abstract

IntroductionSepsis is the main cause of morbidity and mortality in intensive care units and its early diagnosis is not straightforward. Many studies have evaluated the usefulness of various markers of infection, including C-reactive protein (CRP), which is the most accessible and widely used. CRP is of weak diagnostic value because of its low specificity; a better understanding of patterns of CRP levels associated with a particular form of infection may improve its usefulness as a sepsis marker. In the present article, we apply multilevel modeling techniques and mixed linear models to CRP-related data to assess the time course of CRP blood levels in association with clinical outcome in children with different septic conditions.MethodsWe performed a retrospective analysis of 99 patients with systemic inflammatory response syndrome, sepsis, or septic shock who were admitted to the Pediatric Critical Care Unit at the University Hospital, Brno. CRP blood levels were monitored for 10 days following the onset of the septic condition. The effect of different septic conditions and of the surgical or nonsurgical diagnosis on CRP blood levels was statistically analyzed using mixed linear models with a multilevel modeling approach.ResultsA significant effect of septic condition and diagnosis on the course of CRP levels was identified. In patients who did not progress to septic shock, CRP blood levels decreased rapidly after reaching peak values – in contrast to the values in patients with septic shock in whom CRP protein levels decreased slowly. Moreover, CRP levels in patients with a surgical diagnosis were higher than in patients with a nonsurgical condition. The magnitude of this additional elevation in surgical patients did not depend on the septic condition.ConclusionUnderstanding the pattern of change in levels of CRP associated with a particular condition may improve its diagnostic and prognostic value in children with sepsis.

The role of vasopressin and terlipressin in catecholamine-resistant shock and cardio-circulatory arrest in children: Review of the literature

“…2; [5,[18][19][20]34]). The cumulative mortality rate reported in this review is higher when compared to existing data in children with severe septic shock (mortality rate of 10-39%) [54][55][56]. Of note, mortality rates were very high in the study by Yildizdas et al, irrespective of the use of TP [11].…”

“…Future clinical trials need to define the efficacy and safety profile of AVP/TP in different forms of catecholamine-resistant shock in children, and when AVP/TP should best be started. Until more convincing data from these studies will be available, AVP/TP may be considered a rescue therapy in refractory shock that is unresponsive to conventional treatment (adequate fluid resuscitation and high-dose conventional vasopressors) in children, given the high mortality associated with these conditions [54][55][56]. Pending the outcome of ongoing trials, vasopressin/ terlipressin is not recommended as a replacement for vasopressors as a first-line agent [1].…”

Relationship of serum C-reactive protein and blood glucose levels with injury severity and patient morbidity in a pediatric trauma population

“…In addition, children who required admission to the PICU also had higher CRP and blood glucose levels when compared with those who did not. Although the hypothesis that metabolic parameters may be useful to predict the requirement for intensive care has not yet been well tested, data have been generated in both adult and pediatric investigations that support this concept [3,13,17,18].…”

Prognostic Value of High-Sensitivity C-Reactive Protein, Procalcitonin and Pancreatic Stone Protein in Pediatric Sepsis

“…It is caused by numerous infectious agents, inducing multiple organ dysfunction syndrome (MODS), multiple organ failure (MOF), and even death [1]. Several studies have demonstrated that the severity of sepsis, as well as early diagnosis and prognosis were directly related to mortality [2,3]. …”