Vanessa Soares Lanziotti1, Pedro Póvoa2, Arnaldo Prata-Barbosa3, Lucas Berbet Pulcheri4, Ligia S C F Rabello5, José Roberto Lapa E Silva6, Marcio Soares5, Jorge I F Salluh5. 1. D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Internal Medicine, Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro - UFRJ), Rio de Janeiro, RJ, Brazil; Institute of Pediatrics and Child Care Martagão Gesteira, Pediatric Intensive Care Unit, Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro- UFRJ), Rio de Janeiro, RJ, Brazil. Electronic address: vslanziotti@gmail.com. 2. NOVA Medical School, New University of Lisbon, Lisboa, Portugal; Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal. 3. D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil; Department of Pediatrics, School of Medicine, Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro - UFRJ), Rio de Janeiro, RJ, Brazil. 4. Rios D'Or Hospital, Rede D'Or São Luiz, Rio de Janeiro, RJ, Brazil. 5. D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Internal Medicine, Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro - UFRJ), Rio de Janeiro, RJ, Brazil. 6. Postgraduate Program in Internal Medicine, Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro - UFRJ), Rio de Janeiro, RJ, Brazil.
Abstract
PURPOSE: Evaluate sequential C-reactive protein (CRP) measurements and patterns of CRP-ratio response to antibiotic therapy during first 7days in Pediatric Intensive Care Unit (PICU) of septic children. METHODS: Prospective, cohort study of children (1month-12years) admitted at 3 PICUs, with diagnosis of sepsis with <72h course. CRP-ratio was calculated in relation to D0_CRP value. Children were classified according 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: 103 septic children (age-median: 2yrs; 54% male) were prospectively included (infection focus: 65% respiratory, 12.5% central nervous system). Overall PICU mortality was 11.7%. 102 children could be classified according to a predefined CRP-ratio response pattern. Time-dependent analysis of CRP-ratio and CRP course of the different patterns were significantly different. Besides, PICU mortality rate was significantly different according CRP-ratio response patterns: fast response 4.5%; slow response 5.8%; non-response 29.4%; biphasic response 42.8%. CONCLUSIONS: In pediatric sepsis, CRP-ratio serial evaluation was useful in early identification of patients with poor outcome.
PURPOSE: Evaluate sequential C-reactive protein (CRP) measurements and patterns of CRP-ratio response to antibiotic therapy during first 7days in Pediatric Intensive Care Unit (PICU) of septic children. METHODS: Prospective, cohort study of children (1month-12years) admitted at 3 PICUs, with diagnosis of sepsis with <72h course. CRP-ratio was calculated in relation to D0_CRP value. Children were classified according 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: 103 septic children (age-median: 2yrs; 54% male) were prospectively included (infection focus: 65% respiratory, 12.5% central nervous system). Overall PICU mortality was 11.7%. 102 children could be classified according to a predefined CRP-ratio response pattern. Time-dependent analysis of CRP-ratio and CRP course of the different patterns were significantly different. Besides, PICU mortality rate was significantly different according CRP-ratio response patterns: fast response 4.5%; slow response 5.8%; non-response 29.4%; biphasic response 42.8%. CONCLUSIONS: In pediatric sepsis, CRP-ratio serial evaluation was useful in early identification of patients with poor outcome.
Authors: Kusum Menon; Luregn J Schlapbach; Samuel Akech; Andrew Argent; Paolo Biban; Enitan D Carrol; Kathleen Chiotos; Mohammod Jobayer Chisti; Idris V R Evans; David P Inwald; Paul Ishimine; Niranjan Kissoon; Rakesh Lodha; Simon Nadel; Cláudio Flauzino Oliveira; Mark Peters; Benham Sadeghirad; Halden F Scott; Daniela C de Souza; Pierre Tissieres; R Scott Watson; Matthew O Wiens; James L Wynn; Jerry J Zimmerman; Lauren R Sorce Journal: Crit Care Med Date: 2022-01-01 Impact factor: 9.296
Authors: Michael M Hermon; Theresa Etmayr; Jennifer Bettina Brandt; Kambis Sadeghi; Gudrun Burda; Johann Golej Journal: Wien Med Wochenschr Date: 2020-10-27