Procalcitonin for Predicting Sepsis in Infants in the Emergency Department: A Retrospective Study.

Abstract

Background: Among children younger than 5 years, infectious conditions account for the majority of pediatric emergency department visits. Due to nonspecific presentation, early identification of Sepsis and serious bacterial infection is challenging. Procalcitonin (PCT) level has been examined as a marker of sepsis. It has been shown to have advantages over other inflammatory markers.

Aim: This study aimed to evaluate the association between high PCT levels and positive blood, urine, or cerebrospinal fluid (CSF) cultures in all infant patients suspected of having sepsis/Serious bacterial infections (SBIs) clinically or using the Pediatric Early Warning as integration between elevated PCT and culture-proven infections with PEWS to improve early risk stratification and guide clinical decision-making in a tertiary.

Methods: This retrospective cross-sectional study included all patients aged 28 to 90 days whose PCT was obtained simultaneously with blood, urine, or CSF cultures and a viral nasopharyngeal aspirate, taken under suspicion of sepsis/SBIs, from January 2020 to December 2021. All statistical analyses were performed using the SPSS software (IBM) version 27.0.1.

Findings: This study included 352 patients. In total, 205 (58.2%) were between 28 and 60 days old, while 147 (41.8%) were aged 60-90 days. The association between the PCT levels and blood culture outcomes was not statistically significant. However, the association between PCT levels and positive urine culture was statistically significant (p = 0.008). In addition, the analysis revealed a nonsignificant association between PCT levels and respiratory viral infection.

Conclusion: In this cohort, as a single center, PCT level is not a predictor of positive blood or CSF culture results. In contrast, high PCT levels are significantly associated with positive urinary culture results. The study was conducted at a single center with small sample size which may affect the generalizability of its findings. Future multicenter research with large sample size is required to validate the study findings.