Does serial procalcitonin monitoring predict clinical outcomes in children with sepsis? A diagnostic stewardship study.

Objective: To determine if the initial procalcitonin level and the serial trend of procalcitonin levels in blood were predictive of clinical outcomes in children with sepsis.

Design: A retrospective cohort study.

Setting: One primary-to-quaternary care pediatric healthcare system from May 2020 to May 2022.

Participants: Encounters for children 1 to 18 years old with a sepsis ICD-10 diagnosis code and clinical sepsis were included.

Methods: Procalcitonin clearance at 48 hours (CL-PCT₄₈) was defined as the difference in procalcitonin values drawn on admission and at 48 hours divided by initial procalcitonin value. The primary outcome was early clinical stability. Receiver operating characteristic analysis was performed to measure the correlation of CL-PCT₄₈ and initial procalcitonin value (PCT₀) with the outcomes.

Results: 320 unique encounters met the clinical criteria of sepsis with at least two procalcitonin values. 187 encounters had procalcitonin collected at eligible times. The mean age of the participants was 9 years and 8 months, 103 (55%) were male, and 74 (40%) were Hispanic. 78 (41.7%) individuals had good early clinical response, and 177 (94.7%) survived. There was no correlation identified between CL--PCT₄₈ and early clinical stability (area under ROC curve [AUC] = 0.57, 95% CI 0.48-0.65) or mortality (AUC = 0.60, 95% CI 0.43-0.76). There was also no correlation between PCT₀ and early clinical stability (AUC = 0.47, 95% CI 0.39-0.56) or mortality (AUC = 0.50, 95% CI 0.29-0.72).

Conclusion: Procalcitonin clearance at 48 hours after admission did not predict early clinical stability in children with sepsis.