Procalcitonin as a Sepsis Biomarker in Children: Diagnosis, Prognosis, and Antibiotic Stewardship
This focused review evaluates procalcitonin's three roles in pediatric sepsis management: early identification, risk stratification, and antibiotic guidance. While PCT shows promise for distinguishing bacterial from non-bacterial causes of systemic inflammation in children, the evidence base is smaller than in adults. Key challenges include age-dependent physiological variation, limited pediatric RCTs for antibiotic stewardship, and the need for population-specific cut-offs in neonates and infants.
The original study
Utility of Procalcitonin as a Biomarker for Sepsis in Children.
- Authors
- Downes KJ, Fitzgerald JC, Weiss SL
- Journal
- Journal of clinical microbiology
- Type
- Journal Article, Research Support, N.I.H., Extramural, Review
- PMID
- 32350044
Original abstract
Sepsis is a complex process defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It is associated with significant morbidity and mortality rates in both adults and children, and emphasis has been placed on its early recognition and prompt provision of antimicrobials. Owing to limitations of current diagnostic tests (i.e., poor sensitivity and delayed results), significant research has been conducted to identify sepsis biomarkers. Ideally, a biomarker could reliably and rapidly distinguish bacterial infection from other, noninfectious causes of systemic inflammatory illness. In doing so, a sepsis biomarker could be used for earlier identification of sepsis, risk stratification/prognostication, and/or guidance of antibiotic decision-making. In this minireview, we review one of the most common clinically used sepsis biomarkers, procalcitonin, and its roles in sepsis management in these three areas. We highlight key findings in the adult literature but focus the bulk of this review on pediatric sepsis. The challenges and limitations of procalcitonin measurement in sepsis are also discussed.