Evaluation of Biomarkers in Patients with Sepsis Diagnosis in Pediatric Intensive Care Unit

Year 2021, Volume: 7 Issue: 2, 77 - 85, 25.06.2020

Hamza Cengiz Kamil Yılmaz , Ayfer Gözü Pirinççioğlu , Ahmet Kan

https://doi.org/10.5455/umj.20210504075319

Abstract

Introduction: Sepsis is one of the leading causes of mortality and morbidity in intensive care units. In this study, we aimed to investigate the etiological cause, focus of infection, culture sample results, and inflammatory markers among patients treated for sepsis at pediatric intensive care units (PICUs).
Materials and Methods: We retrospectively reviewed the medical records of 70 patients aged 1 month to 18 years who were treated for sepsis at PICU between January 2014 and May 2019.
Results: The median age of the patients was 37 months. The most common underlying etiology was respiratory failure (70%). The most common site of infection causing sepsis was the respiratory system (n:40, 57%). The most commonly isolated agents were Proteus mirabilis and Acinetobacter baumannii. Whereas C reactive protein (CRP) was normal at the time of the diagnosis of sepsis in 28.5% (n=20) of the patients, procalcitonin (PCT) was elevated in all of them. A comparison of the laboratory parameters in the first 24 hours after the diagnosis of sepsis and at the end of the treatment revealed a significant difference between White blood cell (WBC) count, neutrophil-lymphocyte ratio (NLR), the levels of C reactive protein (CRP) and Procalcitonin (p<0.05). In addition, positive correlations were detected between NLR, CRP and PCT (p=0.036, p=0.012/ r=0.251, r:0.299, respectively).
Conclusion: We believe that PCT, CRP, and NLR can be used as biomarkers for monitoring patients with sepsis.

Keywords

CRP, NLR, PICU, procalcitonin, sepsis

References

• 1. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55
• 2. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; International Sepsis Definitions Conference. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003 Apr;29(4):530-8
• 3. Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. 2016 May 23;353:i1585
• 4. Uhle F, Lichtenstern C, Brenner T, Weigand MA. Sepsis und Multiorganversagen - Pathophysiologie der Sepsis. Anasthesiol Intensivmed Notfallmed Schmerzther. 2015 Feb;50(2):114-22
• 5 Font MD, Thyagarajan B, Khanna AK. Sepsis and Septic Shock - Basics of diagnosis, pathophysiology and clinical decision making. Med Clin North Am. 2020 Jul;104(4):573-585
• 6. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003 Jan 9;348(2):138-50
• 7. Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005 Jan;6(1):2-8
• 8. Bustos B R, Padilla P O. Valor predictivo de la procalcitonina en niños con sospecha de sepsis [Predictive value of procalcitonin in children with suspected sepsis]. Rev Chil Pediatr. 2015 Sep-Oct;86(5):331-6
• 9. Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003Jun;31(6):1737-41
• 10. Rey C, Los Arcos M, Concha A, Medina A, Prieto S, Martinez P, Prieto B. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intensive Care Med. 2007 Mar;33(3):477-84
• 11. Standage SW, Wong HR. Biomarkers for pediatric sepsis and septic shock. Expert Rev Anti Infect Ther. 2011 Jan;9(1):71-9
• 12. Lanziotti VS, Póvoa P, Prata-Barbosa A, et al. Patterns of C- reactive protein ratio response to antibiotics in pediatric sepsis: A prospective cohort study. J Crit Care. 2018;44:217-222
• 13. Aygun F. Procalcitonin Value Is an Early Prognostic Factor Related to Mortality in Admission to Pediatric Intensive Care Unit. Crit Care Res Pract. 2018;2018:9238947
• 14. Lindell RB, Nishisaki A, Weiss SL, Traynor DM, Fitzgerald JC. Risk of Mortality in Immunocompromised Children With Severe Sepsis and Septic Shock. Crit Care Med. 2020;48(7):1026-1033
• 15. Boeddha NP, Schlapbach LJ, Driessen GJ, et al. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Crit Care. 2018;22(1):143
• 16. Xiao C, Wang S, Fang F, et al. Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China. Pediatr Crit Care Med. 2019;20(12):1118-1125
• 17. Workman JK, Ames SG, Reeder RW, et al. Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes. Pediatr Crit Care Med. 2016;17(10):e451-e458
• 18. Katu S, Suwarto S, Pohan H, Abdullah M. Factors that influence the success of empirical antibiotic therapy in patients with severe sepsis and septic shock in the inpatient ward of the Hospital Cipto Mangunkusumo. Indones Int Med J. 2015;2:96-106
• 19. Demirdag K, Özden M, Gödekmerdan A, Cihangiroğlu M, Kalkan A. Sepsis olgularında prokalsitonin, TNF-α ve C-reaktif protein düzeylerinin değerlendirilmesi. Klimik dergisi. 2003;16(1): 21-4
• 20. Cleland DA, Eranki AP. Procalcitonin. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 3, 2020
• 21. Faraj M, Salem N. C-reactive protein. Intech Journal, 2012, 89-100
• 22. Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, & Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Critical care medicine. 2003;31(6),1737–41
• 23. Nargis W, Ibrahim, M, Ahamed BU. Procalcitonin versus C- reactive protein: Usefulness as biomarker of sepsis in ICU patient. International journal of critical illness and injury science. 2014;4(3),195–199
• 24. Djordjevic D, Rondovic G, Surbatovic M, et al. Neutrophil- to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to- Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia?. Mediators Inflamm. 2018;2018:3758068
• 25. de Jager CP, van Wijk PT, Mathoera RB, de Jongh- Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14(5):R192
• 26Ljungström L, Pernestig AK, Jacobsson G, Andersson R, Usener B, Tilevik D. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and atients with suspected bacterial sepsis. PLoS One. 017;12(7):e0181704
• 27. Loonen AJ, de Jager CP, Tosserams J, et al. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS One. 2014;9(1): e87315
• 28. Alkan Ozdemir S, Arun Ozer E, Ilhan O, Sutcuoglu S. Can neutrophil to lymphocyte ratio predict late-onset sepsis in preterm infants?. J Clin Lab Anal. 2018;32(4):e22338
• 29. Can E, Hamilcikan Ş, Can C. The Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio for onset Neonatal Sepsis. J Pediatr Hematol ncol. 2018;40(4):e229-e232