Patterns of C-reactive protein ratio response to antibiotics in pediatric sepsis: A prospective cohort study☆

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Abstract

Purpose:

Evaluate 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.

Methods:

Prospective, cohort study of children (1 month-12 years) admitted at 3 PICUs, with diagnosis of sepsis with <72 h 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: 2 yrs; 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.

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