The association between serum procalcitonin levels and outcomes of patients admitted to two tertiary paediatric intensive care units in the Bloemfontein academic complex: a retrospective analytical study
| dc.contributor.advisor | Pienaar, M. A. | |
| dc.contributor.author | Luyo Sanchez, Augusto Martin | |
| dc.date.accessioned | 2022-07-04T10:14:48Z | |
| dc.date.available | 2022-07-04T10:14:48Z | |
| dc.date.issued | 2021-01 | |
| dc.description.abstract | Background: The risk of mortality should be assessed in all patients admitted to the Paediatric Intensive Care Unit (PICU). Procalcitonin (PCT) is a valuable biomarker in the diagnosis of sepsis in the PICU. Its use as a prognostic marker has been widely investigated with conflicting results. This study was done to assess the association between PCT and outcomes in the PICU in our setting thereby investigating its prognostic capabilities. Objectives: The primary objectives were to determine the admission PCT, the PCT between 48 – 72 hours of admission, and the PCT change within this time frame, of patients admitted to the PICU at two tertiary hospitals within the Bloemfontein academic complex as well as their primary (PICU mortality) and secondary (length of PICU stay, number of ventilatory days) outcomes. The secondary objectives were to compare these PCT trends with the primary and secondary outcomes. Methods: The study was a retrospective analytical cross-sectional medical record review of patients, between 1 to 60 months of age, who were admitted to the PICU within the Bloemfontein academic hospital complex from 01 January 2017 to 31 December 2018. Admission PCT and trends within 72 hours of admission were compared to the participant outcomes (PICU mortality, length of PICU stay and number of ventilator days). Data was obtained from the participants electronic and paper medical records and the National Health Laboratory Services database. De-identified data was submitted for analysis by the Department of Biostatistics, University of Free State. Results: 381 participants were included in the study. 55 participants died. 220 required mechanical ventilation. The median length of PICU stay was 6 days. Non-survivors had a higher median admission PCT (13.94ng/ml, IQR 1.0 – 100.0) than survivors (1.45ng/ml, IQR 0.36 – 13.08) (p<0.0001, 95% CI 1.28 – 15.12). Non-survivors had a higher median PCT at 48-72(12.79ng/ml, IQR 2.08 – 100.00) hours than survivors (1.31ng/ml, IQR 0.29 – 7.15) (p<0.0001, 95% CI 2.50 – 21.72). Non-survivors had less of a median decrease in PCT (-0.12ng/ml, IQR -3.68 to +4.125) than survivors (-0.40ng/ml, IQR -4.88 to +0.05) (p=0.22, 95% CI -0.59 - 4.72). The area under the receiver operating characteristics curve (AUROCC) for admission PCT to discriminate for mortality was 0.6702 and for the 48-72-hour PCT it was 0.7369. The strongest profile for PCT to discriminate for mortality was found at the 48-72hour PCT at a threshold of 3.16ng/ml (sensitivity 73.3%; specificity 64.5%). The median PCT change in participants requiring ventilation (-0.23ng/ml, IQR -2.72 to +0.52) was less than for those not requiring ventilation (-0.76ng/ml, IQR -6.34 to -0.05) (p= 0.0044, 95% CI -1.67 - -0.16). There was a positive correlation between PCT and number of ventilator days (spearman correlation co-efficient =0.1477, p=0.0138). There was no significant correlation between the length of PICU stay and admission PCT(p=0.7579), the PCT change (p=0.2034) or the percentage PCT change (p=0.2625). Conclusion: PCT displays some ability to discriminate for PICU mortality. Serial PCT measurements provide greater prognostic information. Non-survivors had a significantly greater median admission PCT, median PCT at 48-72 hours and a lower median PCT decrease than survivors. PCT above 3.16ng/ml at 48-72 hours had the strongest profile to discriminate for mortality. | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11660/11741 | |
| dc.language.iso | en | en_ZA |
| dc.publisher | University of the Free State | en_ZA |
| dc.rights.holder | University of the Free State | en_ZA |
| dc.subject | Dissertation (M.Med. (Paediatrics and Child Health))--University of the Free State, 2021 | en_ZA |
| dc.subject | Biomarker | en_ZA |
| dc.subject | Critical care | en_ZA |
| dc.subject | Endogenous peptide | en_ZA |
| dc.subject | Inotropes | en_ZA |
| dc.subject | Length of stay | en_ZA |
| dc.subject | Mechanical ventilation | en_ZA |
| dc.subject | Mortality | en_ZA |
| dc.subject | Nanograms per millilitre | en_ZA |
| dc.subject | Procalcitonin | en_ZA |
| dc.subject | Prognosis | en_ZA |
| dc.subject | Sepsis | en_ZA |
| dc.subject | Septic shock | en_ZA |
| dc.subject | Serum | en_ZA |
| dc.subject | SIRS | en_ZA |
| dc.subject | Ventilation days | en_ZA |
| dc.title | The association between serum procalcitonin levels and outcomes of patients admitted to two tertiary paediatric intensive care units in the Bloemfontein academic complex: a retrospective analytical study | en_ZA |
| dc.type | Dissertation | en_ZA |