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). xii 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.