Chulalongkorn Medical Journal


Background : Bacterial sepsis remains one of the leading causes of mortality andmorbidity among children. Early identification of individuals at risk ofdeveloping life-threatening sepsis could enable early treatment and improveoutcomes. Procalcitonin (PCT), the peptide hormone precursor of calcitonin,and Interleukin-6 (IL-6), the pro-inflammatory cytokine, are both substancesthat present in higher concentrations after inflammation. The potential valueof measuring PCT and IL-6 levels are recognized as biological markers inpediatric patients with systemic inflammatory response syndrome (SIRS)in both early diagnosis of sepsis and to differentiate sepsis from the otherSIRS non-septic conditions, has higher accuracy than the routine laboratorytests pragmatically such as total leukocytes count and C-reactive protein(CRP).Objectives : To define the clinical and laboratory predictive factors for early diagnosisin pediatric bacterial sepsis and distinguishing from the other SIRSnon-septic conditions, including the development of the risk scoring systemfor pediatric bacterial sepsis prediction.Methods : The diagnostic prediction research was designed from the prospectivedata from September 2015 to June 2016 at the Department of Pediatrics,Bhumibol Adulyadej Hospital, Bangkok, Thailand. Forty-nine patients fromthe age of 1 month to 15 years old who met the criteria of SIRS definitionwere recruited into the study. Multivariable logistic regression was performedto select the strongest predictors then transformed to develop the finalbacterial sepsis score (FBAC score).Results : The best clinical and laboratory predictors included female gender, PCT,IL-6, CRP levels prior to treatment on admission date and CRP level at24 hours after starting of the treatment. The developed FBAC score predictedbacterial sepsis correctly with an AuROC of 86.5%. The patients who haveFBAC scores below 10 (low risk category) will have the chance to bebacterial sepsis 10 times less (likelihood ratio of positive; LHR + 0.1,P - value 0.01) and the potential bacterial septic patients will have morethan 6 times increasingly (LHR+ 6.13, P - value 0.02) if their total FBACscores are higher than 30 (high risk category).Conclusions : The developed FBAC scores will help pediatricians to predict bacterialsepsis for early treatment intervention and can distinguish bacterial sepsisfrom the other SIRS non-septic conditions.



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