Abstract:
Paediatric sepsis remains a major public health problem with significant morbidity and mortality
especially in developing countries. Clinical symptoms associated with sepsis are unreliable and laboratory parameters
unspecific, making an early diagnosis of paediatric sepsis difficult. The lack of definitive biomarker(s) for
early diagnosis of sepsis further leads to the misuse of antibiotics. Diagnosis based on a single biomarker does not
provide adequate accuracy. Subsequently, combining multiple biomarkers into a single score will help clinicians
make a better diagnostic judgment.
Aims: This study for the first time evaluated the individual and combined diagnostic accuracy of procalcitonin
(PCT), presepsin (sCD14-ST) and high sensitive C-reactive protein (hs-CRP) using a Bioscore model.
Materials and methods: In a case control study conducted at the Paediatric Emergency Unit (PEU) and the Mother
and Baby Unit (MBU) of Komfo Anokye Teaching Hospital (KATH), sixty (60) paediatric subjects aged zero to six
(0–6) years, were diagnosed with sepsis using case-definition by the national neonatal bloodstream infection
surveillance and Pediatric Sepsis Consensus Congress. Thirty (30) other paediatric subjects, aged and sex matched
without sepsis or inflammatory conditions were used as controls. One-time blood sample was taken at the time of
admission for blood culture and measurement of PCT, hs-CRP, and presepsin by ELISA. The Statistical Package for
Social Sciences (SPSS release 20.0, Copyright ©SPSS Inc.) was used for analysis.
Results: Out of the sixty septic paediatric subjects, 14 patients (23.3%) had positive blood cultures (LCS) and 46
(76%) had negative for blood cultures (CS). Klebsiella spp. recorded the highest median levels of PCT, and hs-CRP
while Pseudo. Aeruginasa recorded the highest of sCD14-ST levels. Significant elevations in PCT, sCD14-ST and hs-
CRP levels were observed among septic cases in comparison to controls (p < 0.0001). Individually, PCT showed
better accuracy (AUC ¼ 78.7%) followed by hs-CRP (AUC ¼ 78.4%) and sCD14-ST (AUC ¼ 74.8%). Combination
of PCT þ hs-CRP had the highest accuracy (AUC ¼ 80.1%) followed by hs-CRP þ sCD14-ST (AUC ¼ 77.2%), PCT
þ sCD14-ST þ hs-CRP (AUC ¼ 77.0%) and PCT þ sCD14-ST (AUC ¼ 75.9%).
Conclusion: hs-CRP, PCT, and sCD14-ST are independent predictors of paediatric sepsis due to their high prognostic
values. Moreover, Bioscore combination of these biomarkers was significantly associated with increased
odds for sepsis. The incorporation of these biomarkers into routine diagnostic tests will aid in prompt diagnosis of
paediatric sepsis.
