Lanziotti YS, et al. - This study was performed to assess sequential C-reactive protein (CRP) measurements and patterns of CRP-ratio response to antibiotic therapy during first 7 days in Pediatric Intensive Care Unit (PICU) of septic children. Findings revealed that in pediatric sepsis, patients with poor outcome could be identified with the help of CRP-ratio serial evaluation.

Methods

• Researchers performed a prospective, cohort study of children (1 month-12 years) admitted at 3 PICUs, with diagnosis of sepsis with <72 h course.
• They performed calculation of CRP-ratio in relation to D0_CRP value.
• Classification of children was performed in accordance to an individual pattern of CRP-ratio response: fast – CRP_D4 of therapy was <0.4 of D0_CRP; slow – continuous but slow decrease of CRP; non – CRP remained ≥0.8 of D0_CRP; biphasic – initial CRP decrease to levels <0.8 of D0_CRP followed by secondary rise ≥0.8.

Results

• Researchers included 103 septic children (age-median: 2 yrs; 54% male) prospectively (infection focus: 65% respiratory, 12.5% central nervous system).
• They observed an overall PICU mortality of 11.7%.
• According to a predefined CRP-ratio response pattern, 102 children could be classified.
• In this study, they identified significant differences in time-dependent analysis of CRP-ratio and CRP course of the different patterns.
• In addition, significant differences in accordance to CRP-ratio response patterns in PICU mortality rate was observed: fast response 4.5%; slow response 5.8%; non-response 29.4%; biphasic response 42.8%.