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Procalcitonin does discriminate between sepsis and systemic inflammatory response syndrome

¹ Laboratory of Medical Investigation–LIM/36–Department of Pediatrics, School of Medicine, University of São Paulo, Brazil
² Pediatric Intensive Care Unit–"Instituto da Criança do Hospital das Clínicas", School of Medicine, University of São Paulo, Brazil
³ NuCAMPE–"Núcleo de Consultoria e Apoio em Metodologia de Pesquisa e Estatística do Instituto da Criança–Hospital das Clínicas", São Paulo, Brazil
⁴ Department of Anestesiology, "Instituto do Coração do Hospital das Clínicas"–School of Medicine, University of São Paulo, Brazil
⁵ Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

Correspondence to:
Correspondence to:
Dr T S Okay
Laboratório de Investigação Médica–LIM/36–Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647, 05403-900 São Paulo–SP Brazil; tsokay{at}icr.hcnet.usp.br

Aims: To evaluate whether procalcitonin (PCT) and C reactive protein (CRP) are able to discriminate between sepsis and systemic inflammatory response syndrome (SIRS) in critically ill children.

Methods: Prospective, observational study in a paediatric intensive care unit. Kinetics of PCT and CRP were studied in patients undergoing open heart surgery with cardiopulmonary bypass (CPB) (SIRS model; group I1) and patients with confirmed bacterial sepsis (group II).

Results: In group I, PCT median concentration was 0.24 ng/ml (reference value <2.0 ng/ml). There was an increment of PCT concentrations which peaked immediately after CPB (median 0.58 ng/ml), then decreased to 0.47 ng/ml at 24 h; 0.33 ng/ml at 48 h, and 0.22 ng/ml at 72 h. CRP median concentrations remained high on POD1 (36.6 mg/l) and POD2 (13.0 mg/l). In group II, PCT concentrations were high at admission (median 9.15 ng/ml) and subsequently decreased in 11/14 patients who progressed favourably (median 0.31 ng/ml). CRP levels were high in only 11/14 patients at admission. CRP remained high in 13/14 patients at 24 h; in 12/14 at 48 h; and in 10/14 patients at 72 h. Median values were 95.0, 50.9, 86.0, and 20.3 mg/l, respectively. The area under the ROC curve was 0.99 for PCT and 0.54 for CRP. Cut off concentrations to differentiate SIRS from sepsis were >2 ng/ml for PCT and >79 mg/l for CRP.

Conclusion: PCT is able to differentiate between SIRS and sepsis while CRP is not. Moreover, unlike CRP, PCT concentrations varied with the evolution of sepsis.

Abbreviations: CPB, cardiopulmonary bypass; CRP, C reactive protein; PCT, procalcitonin; POD, post-operation day; SIRS, systemic inflammatory response syndrome

Keywords: procalcitonin (PCT); C reactive protein (CRP); cardiopulmonary bypass (CPB); systemic inflammatory response syndrome (SIRS); sepsis