Serum procalcitonin and C-reactive protein as indices of early sepsis and mortality in North Indian pediatric burn injuries: a prospective evaluation and literature review
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Background: Delays in diagnosing sepsis in children afflicted with thermal injuries can result in high morbidity and mortality. Our study evaluated the role of the biomarkers Procalcitonin (PCT) and C-reactive protein (CRP) as predictors of early sepsis and mortality, respectively, in this group of patients. Methods: This was a prospective evaluation of 90 pediatric burn cases treated at a tertiary care burn center in Northern India. Patients, aged 1–16 years, presenting within 24 hours of being burned, with >10% body surface area of burn injury were included in the study. Levels of PCT and CRP were measured on days 1, 3, 5, and 7. Patients were followed until discharge, 30th post-burn day, or death, whichever occurred first. Results: Sepsis was clinically present in 49 of 90 (54.4%) cases with a median 30% total body surface area (TBSA) of burns. Mortality was seen in 31 of 90 (34.4%) cases with a median of 35% TBSA burns. High PCT and CRP were seen in the sepsis group, particularly on days 3, 5, and 7. PCT was also significantly higher in the mortality group (days 1 and 3). Conclusions: While PCT was a good early predictor of sepsis and mortality in children with burns, CRP was reliable as a predictor of sepsis only. Both markers, however, can serve as adjuncts to culture sensitivity reports for diagnosing early onset sepsis and initiation of antibiotic therapy in appropriate patients.
Abstract
Background: Delays in diagnosing sepsis in children afflicted with thermal injuries can result in high morbidity and mortality. Our study evaluated the role of the biomarkers Procalcitonin (PCT) and C-reactive protein (CRP) as predictors of early sepsis and mortality, respectively, in this group of patients. Methods: This was a prospective evaluation of 90 pediatric burn cases treated at a tertiary care burn center in Northern India. Patients, aged 1–16 years, presenting within 24 hours of being burned, with >10% body surface area of burn injury were included in the study. Levels of PCT and CRP were measured on days 1, 3, 5, and 7. Patients were followed until discharge, 30th post-burn day, or death, whichever occurred first. Results: Sepsis was clinically present in 49 of 90 (54.4%) cases with a median 30% total body surface area (TBSA) of burns. Mortality was seen in 31 of 90 (34.4%) cases with a median of 35% TBSA burns. High PCT and CRP were seen in the sepsis group, particularly on days 3, 5, and 7. PCT was also significantly higher in the mortality group (days 1 and 3). Conclusions: While PCT was a good early predictor of sepsis and mortality in children with burns, CRP was reliable as a predictor of sepsis only. Both markers, however, can serve as adjuncts to culture sensitivity reports for diagnosing early onset sepsis and initiation of antibiotic therapy in appropriate patients.
참고문헌 (50)
- Burd A, "A global study of hospitalized paediatric burn patients", Burns, 31, pp.432~438 (2005)
- Sengoelge M, "The global burden of child burn injuries in light of country level economic development and income inequality", Prev Med Rep, 6, pp.115~120 (2017)
- Greenhalgh DG, "American Burn Association consensus conference to define sepsis and infection in burns", J Burn Care Res, 28, pp.776~790 (2007)
- Greenhalgh DG, "Sepsis in the burn patient : a different problem than sepsis in the general population", Burns Trauma, 5, pp.23~ (2017)
- Martinez R, "Role of procalcitonin in paediatric burn wound sepsis", S Afr Med J, 108, pp.793~794 (2018)
- Barati M, "Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases", Burns, 34, pp.770~774 (2008)
- Mann EA, "Use of procalcitonin for the detection of sepsis in the critically ill burn patient : a systematic review of the literature", Burns, 37, pp.549~558 (2011)
- Lavrentieva A, "PCT as a diagnostic and prognostic tool in burn patients : whether time course has a role in monitoring sepsis treatment", Burns, 38, pp.356~363 (2012)
- Pruchniewski D, "C-reactive protein in management of children's burns", Ann Clin Res, 19, pp.334~338 (1987)
- Neely AN, "Efficacy of a rise in C-reactive protein serum levels as an early indicator of sepsis in burned children", J Burn Care Rehabil, 19, pp.102~105 (1998)
- Jeschke MG, "Can we use C-reactive protein levels to predict severe infection or sepsis in severely burned patients?", Int J Burns Trauma, 3, pp.137~143 (2013)
- Rosanova MT, "Assessment of C-reactive protein and procalcitonin levels to predict infection and mortality in burn children", Arch Argent Pediatr, 113, pp.36~41 (2015)
- Abdel-Hafez NM, "A study on biomarkers, cytokines, and growth factors in children with burn injuries", Ann Burns Fire Disasters, 20, pp.89~100 (2007)
- Neely AN, "Procalcitonin in pediatric burn patients : an early indicator of sepsis?", J Burn Care Rehabil, 25, pp.76~80 (2004)
- Hollén L, "Use of procalcitonin as a biomarker for sepsis in moderate to major paediatric burns", Trauma, 21, pp.192~200 (2019)
- Kundes MF, "Value of procalcitonin levels as a predictive biomarker for sepsis in pediatric patients with burn injuries", Niger J Clin Pract, 22, pp.881~884 (2019)
- Cabral L, "The use of procalcitonin(PCT)for diagnosis of sepsis in burn patients : a meta-analysis", PLoS One, 11, pp.e0168475~ (2016)
- Mokline A, "Procalcitonin : a diagnostic and prognostic biomarker of sepsis in burned patients", Ann Burns Fire Disasters, 28, pp.116~120 (2015)
- Avni T, "Prophylactic antibiotics for burns patients : systematic review and meta-analysis", BMJ, 340, pp.c241~ (2010)
- Wibbenmeyer L, "Prospective analysis of nosocomial infection rates, antibiotic use, and patterns of resistance in a burn population", J Burn Care Res, 27, pp.152~160 (2006)
- Mukerji G, "Epidemiology of paediatric burns in Indore, India", Burns, 27, pp.33~38 (2001)
- Oncul U, "Use of procalcitonin as a biomarker for sepsis in pediatric burns", Eur J Pediatr, 182, pp.1561~1567 (2023)
- Duke J, "A study of burn hospitalizations for children younger than 5 years of age : 1983-2008", Pediatrics, 127, pp.e971~e977 (2011)
- Ozkan GY, "Burn, introduction, epidemiology, etiology", Turkiye Klin J Surg Med Sci, 3, pp.1~3 (2007)
- Peddi M, "The persistent paradigm of pediatric burns in India : an epidemiological review", Indian J Burn, 22, pp.93~97 (2014)
- Dhopte A, "A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India", Burns Trauma, 5, pp.30~ (2017)
- Reinhart K, "Procalcitonin as a marker of the systemic inflammatory response to infection", Intensive Care Med, 26, pp.1193~1200 (2000)
- Arora S, "Procalcitonin levels in survivors and nonsurvivors of sepsis : systematic review and meta-analysis", Shock, 43, pp.212~221 (2015)
- Bouadma L, "Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units(PRORATA trial) : a multicentre randomised controlled trial", Lancet, 375, pp.463~474 (2010)
- Póvoa P, "C-reactive protein : a valuable marker of sepsis", Intensive Care Med, 28, pp.235~243 (2002)
- Deepashree G, "Procalcitonin as marker of the severity of sepsis in critically ill children", Indian J Child Health, 3, pp.102~105 (2016)
- Solé-Ribalta A, "Diagnostic and prognostic value of procalcitonin and mid-regional pro-adrenomedullin in septic paediatric patients", Eur J Pediatr, 179, pp.1089~1096 (2020)
- Sachse C, "Procalcitonin as a marker for the early diagnosis of severe infection after thermal injury", J Burn Care Rehabil, 20, pp.354~360 (1999)
- Lubis M, "The usefulness of C-reactive protein, procalcitonin, and PELOD-2 score as a predictive factor of mortality in sepsis", Indones Biomed J, 12, pp.85~188 (2020)
- Siddiqui I, "Relationship of serum procalcitonin, C-reactive protein, and lactic acid to organ failure and outcome in critically ill pediatric population", Indian J Crit Care Med, 22, pp.91~95 (2018)
- Malluvalasa S, "Comparative study of procalcitonin versus c-reactive protein in the diagnosis of sepsis in children below 16 years-a single centre observational study", J Pediatr Res, 4, pp.68~75 (2017)
- Rey C, "Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children", Intensive Care Med, 33, pp.477~484 (2007)
- Prat C, "Use of quantitative and semiquantitative procalcitonin measurements to identify children with sepsis and meningitis", Eur J Clin Microbiol Infect Dis, 23, pp.136~138 (2004)
- Sharma R, "Role of C reactive protein in pediatric sepsis", Int J Healthc Biomed Res, 6, pp.57~63 (2018)
- Permatasari AA, "Role of procalcitonin and C-reactive protein as marker of sepsis in major burn patients : a systematic review and meta-analysis", Open Access Maced J Med Sci, 9, pp.197~203 (2021)
- Angulo M, "Complete blood count and derived indices : evolution pattern and prognostic value in adult burned patients", J Burn Care Res, 41, pp.1260~1266 (2020)
- Qiu L, "Plasma neutrophil-to-lymphocyte ratio on the third day postburn is associated with 90-day mortality among patients with burns over 30% of total body surface area in two Chinese burns centers", J Inflamm Res, 14, pp.519~526 (2021)
- Lin JC, "Prognostic values of platelet distribution width and platelet distribution width-to-platelet ratio in severe burns", Shock, 57, pp.494~500 (2022)
- Rajagopal P, "Utility of haemogram parameters in mortality risk prediction of critically ill patients", J Evol Med Dent Sci, 7, pp.1024~1029 (2018)
- Mısırlıoğlu M, "Platelet-lymphocyte ratio in predicting mortality of patients in pediatric intensive care unit", J Clin Anal Med, 9, pp.488~492 (2018)
- Can E, "The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio for detecting early-onset neonatal sepsis", J Pediatr Hematol Oncol, 40, pp.e229~e232 (2018)
- Dursun A, "Neutrophil-to-lymphocyte ratio and mean platelet volume can be useful markers to predict sepsis in children", Pak J Med Sci, 34, pp.918~922 (2018)
- Mathews S, "Prognostic value of rise in neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)in predicting the mortality in paediatric intensive care", Int J Contemp Pediatr, 6, pp.1052~1058 (2019)
- Fuss J, "Prognostic value of using neutrophil-lymphocyte ratio in patients with burn injury for the diagnosis of sepsis and bacteraemia", Pol Przegl Chir, 90, pp.13~16 (2018)
- Ciftci A, "Could neutrophil-to-lymphocyte ratio be a new mortality predictor value in severe burns?", J Surg Surg Res, 5, pp.26~28 (2019)