Objective To investigate the correlation between serum procalcitonin (PCT) level and pediatric critical illness score (PCIS) and their prognostic values in children with sepsis. Methods Sixty-one children with sepsis in the pediatric intensive care unit were enrolled. According to PCIS, these patients were divided into non-critical (n=18), critical (n=20), and extremely critical groups (n=23). Within 24 hours after admission, serum levels of PCT, C-reactive protein (CRP), and lactic acid (LA) and routine blood counts were measured. These parameters were compared between the three groups. The Pearson correlation analysis was performed to determine the correlation of PCT with PCIS and other serological parameters. Based on clinical outcomes, these patients were divided into survival (n=39) and death groups (n=22). The PCT, PCIS, and other serological parameters were compared between the two groups. Results The serum levels of PCT and CRP in the non-critical group were significantly lower than those in critical group and extremely critical groups (P<0.05), and the two parameters were significantly lower in the critical group than in the extremely critical groups (P<0.05). The extremely critical group had a significantly higher mortality than the critical group non-critical groups (61% vs 35% and 6%, P<0.05). Serum PCT level had a significantly negative correlation with PCIS (r=-0.63, P<0.001) but a significantly positive correlation with serum CRP level (r=0.73, P=0.003). Compared with the death group, the survival group had significantly higher serum levels of PCT and LA (P<0.05) but a significantly lower PCIS (P<0.05). Conclusions There is a good correlation between serum PCT level and PCIS. For children with sepsis, the lower the PCIS, the higher the serum PCT level, resulting in a poorer prognosis. A combination of serum PCT and PCIS can be used as an early prognostic indicator in children with sepsis.
Key words
Procalcitonin /
Sepsis /
Pediatric critical illness score /
Prognosis /
Child
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References
[1] 胡亚美, 江载芳. 诸福棠实用儿科学[M]. 第7 版. 北京: 人 民卫生出版社, 2005: 2559-2567.
[2] Burn-Buisson C. The epidemiology of the systemic inflammatory response[J]. Intensive Care Med, 2000, 26 Suppl 1: S64-S74.
[3] Olaciregui I, Hernandez U, Munoz JA, et al. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin[J]. Arch Dis Child, 2009, 94(7): 501-505.
[4] Venkatesh B, Kennedy P, Kruger PS, et al. Changes in serum procalcitonin and C-reactive protein following antimicrobial therapy as a guide to antibiotic duration in the critically ill: a prospective evaluation[J]. Anaesth Intensive Care, 2009, 37(1): 20-26.
[5] Simon P, Milbrandt EB, Emlet LL. Procalcitonin-guided antibiotics in severe sepsis[J]. Crit Care, 2008, 12(6): 309.
[6] Nakamura A, Wada H, Ikejiri M, et al. Efficacy of procalcitonin in the early diagnosis of bacterial infections in a critical care unit[J]. Shock, 2009, 31(6): 586-591.
[7] 范江花, 祝益民, 张新萍. 脓毒症患儿低蛋白血症与CRP 及 PCT 的相关性[J]. 中国当代儿科杂志, 2010, 12(11): 870-873.
[8] 中华医学会儿科学分会急救学组, 中华医学会急诊学分会儿 科组《中华儿科杂志》编辑委员会. 儿科感染性性休克(脓 毒性休克)诊疗推荐方案[J]. 中华儿科杂志, 2006, 44(8): 596-598.
[9] 中华医学会儿科学会急救组. 小儿危重病例评分法(草案)[J]. 中华儿科杂志, 1995, 33(6): 370-373.
[10] 汪芸, 李尔珍. 降钙素原在临床的应用研究进展[J]. 实用儿 科临床杂志, 2007, 18(3): 1427.
[11] Dahaba AA, Metzler H. Procalcitonin's role in the sepsis cascade. Is procalcitonin a sepsis marker or mediator?[J]. Minerva anestesiol, 2009, 75(7-8): 447-452.
[12] Indino P, Lemarchand P, Bady P, et al. Prospective study on procalcitonin and other systemic infection markers in patients with leukocytosis[J]. Int J Infect Dis, 2008, 12(3): 319-324.
[13] Tang BM, Eslick GD, Craig JC, et al. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis[J]. Lancet Infect Dis, 2007, 7(3): 210-217.
[14] 小儿危重病例评分试用协作组. 小儿危重病例法(草案) 临 床应用的评价[J]. 中华儿科杂志, 1998, 36(10): 579.
[15] Castelli GP, Pognani C, Cita M, et al. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis[J]. Minerva Anestesiol, 2006, 72(1-2): 69-80.
[16] Suarez-Santamaria M, Santolaria F, Perez-Ramirez A, et al. Prognostic value of inflammatory markers (notably cytokines and procalcitonin), nutritional assessment, and organ function in patients with sepsis[J]. Eur Cytokine Netw, 2010, 21(1): 19-26.
[17] Giamarellos-Bourboulis EJ, Tsangaris I, Karenni T, et al. Procalcitonin as an early indicator of outcome in sepsis: a prospective observation study[J]. J Hosp Infect, 2011, 77(1): 58-63.
[18] Rey C, Los Arcos M, Concha A, et al. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children[J]. Intensive Care Med, 2007, 33(3): 477-484.
[19] Muller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in communityacquired pneumonia[J]. BMC Infect Dis, 2007, 7: 10.
[20] Marik PE. Definition of sepsis: not quite time to dump SIRS?[J]. Crit Care Med, 2002, 30(3): 706-708.
[21] 邢豫宾, 戴路明, 赵焕之, 等. 血清降钙素原和常用炎症指 标结合SOFA 评分对脓毒症早期诊断和预后价值的评价[J]. 中国危重病急救医学, 2008, 20(1): 23-28.