Proteina C reattiva e procalcitonina come biomarcatori di sepsi neonatale

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BACKGROUND: All emergency departments face daily challenges in detecting and treating sepsis in an early manner. Today there are a lot of therapeutic approaches that can improve the survival of patients with sepsis. The gold standard for diagnosis is microbiological culture, but it can lead to false negative findings and takes time. In order to identify the bacterial nature of the infection, it is appropriate to monitor inflammatory markers like C-reactive protein (CRP) and procalcitonin (PCT).METHODS: CRP was measured in mg/L by an immunoturbidity method. PCT was determined by electrochemoluminescence and expressed in ng/mL. The range of CRP in children is 0.0-5.0 mg/L, while the range of PCT is 0.0-0.5 ng/mL. The objective of the study was to examine the simultaneous increase of the two inflammatory markers in 585 suspected septic pediatric patients, aged 0-12 months from June 1st, 2022 to June 1st, 2023. We selected children with a PCT >2 ng/mL and a CRP >5 mg/L simultaneously. We then identified a population of clinical interest with a PCT >5 ng/mL and a CRP >5 mg/L (9.6% of the children) and assessed the cause of sepsis, drug therapy, and prognosis.RESULTS: All the study population had values higher than the decision limits for CRP and PCT. The average value for CRP was 49.6 mg/L and it was 3.1 ng/mL for PCT. The 95th percentile of CRP was 49.5 mg/L, and it was 9.1 ng/mL for PCT. In 56 cases out of 585 (9.6%), the plasma concentration values of PCT and of CRP were >5 ng/mL and >5 mg/L, respectively. Twenty-four out of 56 patients (43%) had sepsis from urinary tract infection. Diseases of the respiratory system were the cause of sepsis in 13 (23%), while there were other causes for 19 patients. There were no differences between males and females (29 males and 27 females).CONCLUSIONS: The simultaneous measurement of both PCR and PCT is essential to screen for and monitor sepsis. The prognosis of patients was improved by early detection, while the mortality rate remained at 1.2%. Eighty percent of the observed cases were due to bacterial infection and involved the genitourinary system, with E. coli being the most common type. This study is one of the few that examines sepsis in pediatric patients and offers valuable information for the follow-up of children with sepsis. However, our findings are in line with numerous studies conducted on the adult population. The biochemical data and instrumental analysis remain key points for a correct clinical diagnosis.

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