Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock—A pilot study

Abstract

Purpose: To investigate if reduction in procalcitonin (PCT) provides useful information about 28-day mortality in children with severe sepsis or septic shock. Materials and methods: Design: Prospective observational study. Setting: Mixed adult-pediatric intensive care unit in a teaching hospital. Subjects: Children up to 18 years of age admitted with severe sepsis or septic shock between March 2011 and June 2013. Procalcitonin measured using electrochemiluminescence immunoassay on the day of admission with sepsis (D0) and 72-96 hours later (D4). Reduction in PCT from D0 to D4 correlated with the primary outcome, that is, 28-day mortality. Results: Twenty-five children of median age of 14 years (range, 6-18 years) were included, but 5 died before D4 after admission. Six of the remaining 20 children died between D4 and D28, and 14 survived to D28. At admission, the median of the Pediatric Risk of Mortality III score was 10 (interquartile range [IQR], 5-16) and that of the Sequential Organ Failure Assessment score was 11 (IQR, 7-15). The median PCT level was 9.7 ng/mL on D0 (n = 25) and 3.3 ng/mL on D4 (n = 20). On D0, the median PCT level was 25.0 ng/mL in the 14 survivors and 8.4 ng/mL in the 11 nonsurvivors (P = .075). On D4, the median PCT level was 3.1 ng/mL in the 14 survivors and 4.5 ng/mL in the 6 nonsurvivors who lived to D4 (P = .71); the reduction in PCT (D0 minus D4) was 17.3 ng/mL (IQR, 3.5-38.0 ng/mL) in the survivors and -1.1 ng/mL (IQR, -24.9 to 8.6 ng/mL) in the 6 nonsurvivors (P = .017). Percent reduction in PCT (100 * [D0 - D4]/D0) was 75.5% (IQR, 54.8%-80.7%) in the survivors and -200.3% (IQR, -937.8% to 42.4%) in the 6 nonsurvivors (P = .006). Conclusion: This small pilot study suggests that further studies are indicated to determine whether children with severe sepsis or septic shock are less likely to die if they have a reduction in PCT more than 50% in the first 4 days in intensive care.