PROMISING DIAGNSOTIC MARKER AT NICU AND PICU-NEW APPRROACHES FOR DIAGNOSTIC AND TREATMENT
The aim of this study is evaluate the initial PCT levels on the outcome of patients in pediatric intensive care units and find out if these biomarker can be used to predict sepsis.
The study was designed as a prospective, clinical, investigation conducted in the period sixth months, which included 45 (M:F=25:20) newborns with two or three clinical signs of sepsis hospitalized in the Intensive Care Unit at the PHI University Clinic for Children Diseases. The patient have been divided into two groups: I group included 31 septic newborns with negative blood culture and II group - 14 septic newborns with positive blood cultures. Results of blood count (WBC), CRP and PCT, were recorded.
Procalcitonin PCT levels at first 24 hours of the admission were increased in all 45 newborns (≥2 ng/mL). The values of C-reactive protein gradually increase after 12-36 hours at admission. The second measurement, after 3 days usage of an adequate antibiotic treatment, the levels of PCT is decreased,regardless of whether blood culture is positive or negative, except 5 patients develop severe sepsis, and three patients develop septic shock. After the third measurement the levels of PCT and CRP is decreased. NIV was used in 39.8% patients and Invasive MV was used in 29.8% patients.Sensitivity of procalcitonin 83.5%, Specificity of procalcitonin 81.3%.
Procalcitonin value is a early prognostic factor for sepsis and it is a reliable parameter whether an appropriate antibiotic for the treatment is used,thus increasing newborns safety,and reducing costs .
Antibiotic Stewardship: Opportunities and Challenges.Clinical Chemistry 63:9 1436–1441 (2017)
2. Becker KL, Snider R, Nylen ES. Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a
therapeutic target. Br J Pharmacol 2010;159:253– 64.
3. Sager R, Kutz A, Mueller B, and Schuetz P. Procalcitoninguided diagnosis and antibiotic stewardship
revisited. BMC Medicine 2017;15:15.
4. Meisner M. Update on procalcitonin measurements. Ann Lab Med 2014 Jul;34 (4):263-73
5. Broyles MR. Impact of procalcitonin-guided antibiotic management on antibiotic exposure and outcomes:
realworld evidence. Open Forum Infect Dis 2017;4:4.
6. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang CH, Doi Y, et al. Procalcitonin-guided use of antibiotics for
lower respiratory tract infection. N Engl J Med 2018;379: 236 – 49.
7. Dickerson JA, Fletcher AH, Procop G, Keren D, Singh IR, Garcia JJ, et al. Transforming laboratory utilization
review into laboratory stewardship: guidelines by the PLUGS National Committee for Laboratory
Stewardship. J Appl Lab Med 2017;2:259 – 68.
8. Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, Müller B. Expression and secretion of procalcitonin
and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Crit
Care Med 2004;32:1715–21.
9. Linscheid P, Seboek D, Nylen ES, Langer I, Schlatter M, Becker KL, et al. In vitro and in vivo calcitonin I gene
expression in parenchymal cells: a novel product of human adipose tissue. Endocrinology 2003;144:5578–84.
10. Dellinger RP, Carlet JM, Masur H, et all; Surviving Sepsis Campaign Management
a. Guidelines Committee. Surviving Sepsis Campaign guidelines for management of
b. severe sepsis and septic shock. Crit Care Med 2004 ;32(3):858-73. Review.
11. Llewelyn M, Cohen J; International Sepsis Forum. Diagnosis of infection in sepsis.
c. Intensive Care Med. 2001;27 Suppl 1:S10-32. Review.
12. Giunti M, Peli A, Battilani M, Zacchini S, Militerno G, Otto CM. Evaluation of CALC-I gene (CALCA) expression
in tissues of dogs with signs of the systemic inflammatory response syndrome. J Vet Emerg Crit Care (San Ant.
2010 Oct;20 (5):523-7
13. Lee H. Procalcitonin as a biomarker of infectious diseases. Korean J Intern Med 2013 May;28 (3):285-91
14. Schneider HG, Lam QT. Procalcitonin for the clinical laboratory: a review. Pathology. 2007 Aug;39 (4):383-90
15. Kim H, Kim Y, Lee HK, Kim KH, Yeo CD.Comparison of the delta neutrophil index with procalcitonin and C-
reactive protein in sepsis.Clin Lab 2014;60(12):2015-21.
16. Fioretto J. R. et al.. Comparison between procalcitonin and C-reactive protein for early diagnosis of children
with sepsis or septic shock. Inflamm. Res 59, 581–586 (2010).
17. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M.Procalcitonin increase in early
identification of critically ill patients at high risk of mortality.Crit Care Med 2006 Oct; 34(10):2596-602
18. Kim H, Kim Y, Lee HK, Kim KH, Yeo CD.Comparison of the delta neutrophil index with procalcitonin and C-
reactive protein in sepsis.Clin Lab 2014;60(12):2015-21.
19. Groselj-Grenc M, Ihan A, Pavcnik-Arnol M, Kopitar AN, Gmeiner-Stopar T, Derganc M.Neutrophil and
monocyte CD64 indexes, lipopolysaccharide-binding protein, procalcitonin and C-reactive protein in sepsis of
critically ill neonates and children.Intensive Care Med 2009 Nov;35(11):1950-8. doi: 10.1007/s00134-009-1637-
20. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions:
past, present and future. BMC Med 2011;9:107
21. Ugarte H, Silva E, Mercan D, De Mendonça A, Vincent JL. Procalcitonin used as a marker of infection in the
intensive care unit. Crit Care Med 1999;27:498–504.
22. Hansson LO, Lindquist L. C-reactive protein: its role in the diagnosis and follow-up of infectious diseases.
Curr Opin Infect Dis 1997;10:196–201.
23. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Calandra T, Feld R, Pizzo PA, Rolston KVI, Shenep JL, Young LS.
Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis
2002;34:730–51. doi: 10.1086/339215
24. Caterino J. M., Scheatzle M. D., Forbes M. L. & D’Antonio J. A. Bacteremic elder emergency department
patients: procalcitonin and white count. Acad. Emerg. Med 11, 393–396 (2004).
25. Katz JA, Mustafa MM, Bash RO, Cash JV, Buchanan GR. Value of C-reactive protein determination in the initial
diagnostic evaluation of the febrile, neutropenic child with cancer. Pediatr Infect Dis J 1992;11:708–712.
26. Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, Anargyrou K, Katsilambros N, Giamarellou H. Assessment
of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia. Clin
Infect Dis 2001;32:1718–1728.
27. Castelli GP, Pognani C, Meisner M, Stuani A, Bellomi D, Sgarbi L. Procalcitonin and C-reactive protein during
systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care 2004;8:R234–R242.