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Review
. 2020 Jun 24;58(7):e01851-19.
doi: 10.1128/JCM.01851-19. Print 2020 Jun 24.

Utility of Procalcitonin as a Biomarker for Sepsis in Children

Kevin J Downes  1   2   3   4 , Julie C Fitzgerald  5   6   3   7 , Scott L Weiss  5   6   7
Affiliations
Review

Utility of Procalcitonin as a Biomarker for Sepsis in Children

Kevin J Downes et al. J Clin Microbiol. .

Abstract

Sepsis is a complex process defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It is associated with significant morbidity and mortality rates in both adults and children, and emphasis has been placed on its early recognition and prompt provision of antimicrobials. Owing to limitations of current diagnostic tests (i.e., poor sensitivity and delayed results), significant research has been conducted to identify sepsis biomarkers. Ideally, a biomarker could reliably and rapidly distinguish bacterial infection from other, noninfectious causes of systemic inflammatory illness. In doing so, a sepsis biomarker could be used for earlier identification of sepsis, risk stratification/prognostication, and/or guidance of antibiotic decision-making. In this minireview, we review one of the most common clinically used sepsis biomarkers, procalcitonin, and its roles in sepsis management in these three areas. We highlight key findings in the adult literature but focus the bulk of this review on pediatric sepsis. The challenges and limitations of procalcitonin measurement in sepsis are also discussed.

Keywords: adults; biomarkers; pediatrics; procalcitonin; sepsis.

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Figures

FIG 1
FIG 1
General goals and challenges for use of sepsis biomarkers at onset and during illness.
FIG 2
FIG 2
Example of how measurement of PCT and CRP levels in combination strengthens the performance of biomarkers in pediatric SIRS. Data in figure are derived from the report by Simon et al. (33). In that study of 69 children with SIRS, 24 had bacterial infections (pretest probability, 39%). (A) Use of PCT alone had a positive LR (LR+) of 2.65, increasing the posttest probability to 60%, and a LR− of 0.43, decreasing the posttest probability to 22%. (B) Use of CRP alone had a LR+ of 1.63 (posttest probability, 50%) and a LR− of 0.10 (posttest probability, 6%). (C) Use of the combination of PCT and CRP had a LR+ of 4.32 (posttest probability, 74%) and a LR− of 0.043 (posttest probability, 3%). Discordant CRP and PCT results (not shown) had a LR of 0.27 to 0.70 (posttest probability, 15 to 30%).
FIG 3
FIG 3
Performance of PCT measurement and data supporting its use at sepsis onset and during illness. Green shading denotes the presence of good evidence to support the use of PCT in that scenario. Yellow shading denotes the presence of weak evidence to support the use of PCT in that scenario. Red shading denotes the presence of evidence against the use of PCT in that scenario.
See this image and copyright information in PMC

References

    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. 2016. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315:801–810. doi:10.1001/jama.2016.0287. - DOI - PMC - PubMed
    1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, Colombara DV, Ikuta KS, Kissoon N, Finfer S, Fleischmann-Struzek C, Machado FR, Reinhart KK, Rowan K, Seymour CW, Watson RS, West TE, Marinho F, Hay SI, Lozano R, Lopez AD, Angus DC, Murray CJL, Naghavi M. 2020. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 395:200–211. doi:10.1016/S0140-6736(19)32989-7. - DOI - PMC - PubMed
    1. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, Kadri SS, Angus DC, Danner RL, Fiore AE, Jernigan JA, Martin GS, Septimus E, Warren DK, Karcz A, Chan C, Menchaca JT, Wang R, Gruber S, Klompas M. 2017. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. JAMA 318:1241–1249. doi:10.1001/jama.2017.13836. - DOI - PMC - PubMed
    1. Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. 2013. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med 14:686–693. doi:10.1097/PCC.0b013e3182917fad. - DOI - PubMed
    1. Kondo Y, Umemura Y, Hayashida K, Hara Y, Aihara M, Yamakawa K. 2019. Diagnostic value of procalcitonin and presepsin for sepsis in critically ill adult patients: a systematic review and meta-analysis. J Intensive Care 7:22. doi:10.1186/s40560-019-0374-4. - DOI - PMC - PubMed

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