Acute Crit Care.  2024 Aug;39(3):350-358. 10.4266/acc.2023.00759.

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

• Aggarwal N
• Karki D
• Gaind R
• Matlani M
• Muthukumar V

• KMID: 2563524
• DOI: http://doi.org/10.4266/acc.2023.00759

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.

Keyword

C-reactive protein; mortality; pediatric burns; procalcitonin; sepsis

Figure

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  Figure 1. Graphical representation of variation in procalcitonin (PCT) levels in the sepsis/non-sepsis and survival/non-survival groups on days 1, 3, 5, and 7 of assessment.

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  Figure 2. Graphical representation of variation in C-reactive protein (CRP) levels in the sepsis/non-sepsis and survival/non-survival groups on days 1, 3, 5, and 7 of assessment.

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  Figure 3. Receiver operating characteristic (ROC) curve of day 3 procalcitonin (PCT3) levels in the sepsis group. According to the ROC curve, measurement of PCT levels on day 3 after burn for correlation with sepsis has an AUC of 0.694. In addition, PCT levels above 1.4 ng/ml on day 3 after burn helps predict sepsis, with a sensitivity of 69.4% and specificity of 70%.

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  Figure 4. Receiver operating characteristic (ROC) curve of day 3 and 5 C-reactive protein CRP3 and CRP5 levels in the sepsis group. On the ROC curve, area under the curve values for correlations of day 3 and 5 CRP levels with sepsis in pediatric burns were 0.636 and 0.801, respectively. Day 3 and 5 CRP levels above 1.3 mg/dl and 2 mg/dl in pediatric burns help predict sepsis, with a sensitivity of 75.5% and specificity of 50% and 70%, respectively.

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