Prognostic Role Of Procalcitonin In Children With Sepsis At Kenyatta National Hospital
Abstract
Background
Sepsis is a major cause of morbidity and mortality. The management of the early stages of
sepsis plays a crucial role in the outcome of each patient. Part of this involves the use of
appropriate antibiotic therapy initiated promptly for infection control. Stratification of
patients based on objective markers would help determine the level of aggressiveness of
management with respect to the choice of antibiotics as well as anticipated need for ICU
care. The purpose of this study was to assess whether procalcitonin levels at admission and
three days after admission could be used to determine patients at risk of death within 14
days of their admission.
Study Objectives
Primary Objective:
To determine the prognostic value of serum procalcitonin in children aged 7 days to 12
years with presumed sepsis at Kenyatta National Hospital.
Secondary Objective:
To determine the association between baseline CRP (C-Reactive protein) and WCC (white
cell count) parameters and survival in children with sepsis at Kenyatta National Hospital.
Methodology
This was a hospital based cross-sectional study carried out at Kenyatta National Hospital
between January and February 2018. Patients aged 7 days to 12 years were screened at
admission for features of sepsis for eligibility into the study. Vital signs were recorded at
admission and serum procalcitonin levels measured. Patients with serum procalcitonin
levels above 0.25ng/ml were enrolled into the study. Serum procalcitonin levels were
measured again 72 hours after admission for the patients who were still alive. Fourteen
days after admission, the patient’s hospital records were examined to determine the
outcome of the patient (dead or alive).
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Results
97 patients were enrolled into the study, 55 male and 42 female. The overall mortality rate
was 30.9% (17 female and 13 male). 13% of mortalities occurred within 72 hours from
admission.
Median (IQR) serum procalcitonin levels for survivors vs non-survivors was
2.41ng/ml(0.9-3.4) vs 4.16ng/ml(2.1-5.2). There was a significant association between the
baseline median values and survival at 14 days (p=0.041). The median(IQR) for survivors
vs non-survivors at 72 hours was 0.21ng/ml(0.1-1.0) vs 1.53ng/ml(0.5-2.24).
There was significant association between procalcitonin levels taken at 72 hours and
survival (p=0.020). There was no significant association between the total white cell count
and survival (p=0.282). CRP levels measured at admission showed no significant
association between the baseline values and survival of patients (p value=0.085).
Conclusions
Procalcitonin was predictive of death and survival in our setting. This is similar to findings
in other populations.
Serial procalcitonin measures improved the predictive value of the test with the difference
between the two groups increasing with subsequent procalcitonin measurements.
Serum procalcitonin was a better biomarker of poor outcome in sepsis among children than
CRP and WBC.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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