Use of procalcitonin as a biomarker for sepsis in pediatric burns

Abstract

Introduction: Infection and sepsis continue to be the leading cause of morbidity and death in burn injuries. Diagnosing sepsis in burns is challenging as signs and symptoms of sepsis are not speci c and overlap with those related to the burn injury. While use of procalcitonin (PCT) as a biomarker is recommended for diagnosing sepsis in burns, evidence for children with burns is scarce. In this study, we aimed to investigate the role of PCT for distinguishing sepsis in pediatric burns.Methods: A prospective observational study was conducted in a single pediatric burn unit. Children hospitalized with burns ≤30% of total body surface area were included while patients with chemical burn, inhalation injury or concomitant chronic disease were excluded. Patients were classi ed into three groups for sepsis, systemic in ammatory response syndrome (SIRS) or controls using the American Burn Association (ABA) criteria. Predictive role of C-reactive protein (CRP) and PCT was investigated for distinguishing sepsis.Results: Seventy-two patients were included in the study. Median total body surface area (TBSA) size was 12% (2.0-28.5%) and median abbreviated burn severity index (ABSI) score was 3 (2-7). Median length of burn unit stay was 9.5 days (1-59 days). Sepsis was diagnosed in 11 patients (15.2%) and SIRS was present in 23 patients (40.0%), whereas 38 patients (52.8%) had neither SIRS nor sepsis (control group).Receiver operating characteristic analysis revealed that CRP and PCT levels distinguished sepsis patients from non-sepsis patients while PCT had a higher positive predictive value (64.3% vs 47.6%). Optimal cutoff values of CRP and PCT for distinguishing sepsis were 66.75 mg/L and 2.54 ng/mL. Conclusions: PCT levels could distinguish sepsis in children with burn injuries, performing better than CRP levels. Con rmatory studies are needed to evaluate the development of sepsis and role of PCT for diagnosing sepsis in pediatric burn patients.

Biological markers of sepsis

“…Diagnostics, prognosis of the disease course and outcome [31] Sepsis in children with burn injuries ≥0.95 ng/ml Diagnostic biomarker [35] Adult patients with sepsis ≥0.5 ng/ml Diagnostic biomarker: early diagnostics [34] Patients Prognosis of 28-day mortality [94] Increased level (≥15 ng/l) in survivors of acute phase of disease is an independent predictor of 30-365-day mortality…”

“…It is particularly challenging to diagnose sepsis in cases of burn injuries due to similar symptoms. Elevated PCT levels enable a more reliable diagnosis of sepsis in children with burn injuries compared to CRP [35]. A comparative study conducted by Li et al [36] demonstrated that PCT has a moderate sensitivity (73%) and specificity (75%) when used as a sepsis biomarker in burn patients.…”

The Potential Role of Procalcitonin Compared to C-reactive protein and Neutrophil Lymphocyte Ratio in Prediction of Severity and Outcomes of Acute Corrosive Ingestion

“…Procalcitonin Level was measured using commercial ELISA Kit from Bioassay Technology Laboratory Company, following the manufacturer instructions (Khaleel & Al-Barzinji, 2021;Sinha et al, 2021). While serum CRP was measured with particleenhanced immunoturbidimetric assay on a Cobas c501 device (Roche Diagnostics, Mannheim, Germany) as per manufacturer's instructions (Oncul et al, 2023). b) Barium study: it was done 3 -6 weeks post corrosive ingestion to diagnose GIT stricture or stenosis.…”

Биологические Маркеры Сепсиса

“…Особенно сложно диагностировать сепсис при ожоговой травме ввиду идентичности симптоматики. Повышенное значение уровня PCT позволяет с большей достоверностью диагностировать сепсис у детей с ожоговыми травмами, чем CRP [35]. В сравнительном исследовании, проведенном Li и др.…”