Study of serum levels of CRP and procalcitonin as early marker of sepsis in children with sepsis above neonatal age group

Background: Sepsis caused by infection remains a major cause of mortality and morbidity among children.' Blood culture though gold standard requires lot of time for diagnosis, hence it's necessary to rely on early diagnostic markers such as blood counts, micro-ESR, CRP, Procalcitonin. The objective of this study is to evaluate the serum levels of CRP, Procalcitonin as reliable and as early marker of sepsis in pediatric patients above neonatal age group.Methods: Children aged above neonatal age group with clinically suspected sepsis as per the definition given by the International Paediatric sepsis Consensus Conference were selected. Patients were classified as those with sirs, sepsis, severe sepsis and septic shock. Patients were divided into two groups one with culture proven sepsis and the other with non-culture proven sepsis. All patients had CRP, Procalcitonin levels measured at admission and 24hrs after admission. The primary outcome was to determine reliable marker in differentiating between the culture proven and non-culture proven sepsis, and to determine the early marker of sepsis.Results: Total 104 patients formed the study group, of which 42 belonged to SIRS group, 26 were sepsis, 19 were severe sepsis and 17 were septic shock. A total of 36 cases had culture positive. In present study PCT was found to be more reliable marker of sepsis as the sensitivity and specificity of PCT was more than CRP and AUC for PCT was significantly higher than CRP. PCT was found to be early marker as the AUC for CRP at 24hrs was significantly more than AUC for CRP at admission and there was no statistically significant difference between AUC for PCT at admission and 24 hours after admission.Conclusions: Both CRP and PCT levels have favourable test performance but PCT is more reliable. PCT is earlier to rise compared to CRP.

Hyperuricemia as an Early Marker in Predicting the Mortality and Morbidity in Patients with Sepsis

Introduction: Serum uric acid can be used as a marker ofoxidative stress, and poor prognosis in patients with sepsis,since high levels of oxy radicals, lower oxidant level in sepsispatients result in multi organ failure. Raised uric acid isassociated with chronic diseases and is used as a prognosticindicator of severe infection as it acutely activates varioustranscription factors. Aim: This study aims to understandthe correlation between hyperuricemia and the mortality andmorbidity rate in patients with clinically suspected sepsis(based on Qsofa Criteria - Quick sepsis related organ failure).The secondary end points of the study are to understandcorrelation between hyperuricemia in clinically suspectedsepsis patients and Acute kidney injury, acute respiratorydistress syndrome, and duration of stay in the hospital.Material and methods: We conducted a prospective cohortstudy in clinically suspected sepsis patients {based on theQsofa Criteria} between September2017-2018 in a tertiarycare center in AJ Institute Of Medical Sciences in South India.Patients or their medical power of attorneys provided writteninformed consent. A total no of 60 patients were enrolled basedon the inclusion criteria, clinically suspected sepsis patientsaged more than 18 years. All pregnant female, patients fromoutside facility admitted in the medical intensive care unit formore than 24 hours were excluded. For the purpose of ourstudy we defined hyperuricemia as greater than or equal to7 mg/ dl in both males and females. Patients were divided intwo groups based on the uric acid levels. The first group hadclinically suspected sepsis patients with uric acid levels morethan 7 and the second group had clinically suspected sepsispatients with uric acid level less than 7.Results: More than half of the patients, 55%, with high uricacid were found to be males. The overall mortality rate inpatients with high uric acid levels was found to be 90%. Theprobability of having hyperuricemia with acute kidney injurywas around 92.9%.Conclusion: Hyperuricemia was associated with poorprognosis in clinically suspected sepsis patients

Urinary nephrin: A new predictive marker for pregnancies with preeclampsia and small-for-gestational age infants

OBJECTIVE: The objective of this study was to determine the differences in urinary nephrin among controls, gravidas with preeclampsia (PE), and small-for-gestational age (SGA) infants. We also determined whether or not maternal urinary concentrations of nephrin are associated with the subsequent development of PE and SGA infants. METHODS: We analyzed maternal urinary levels of nephrin in women who were normal controls (n=50), women who were delivered SGA infants (n=40), and gravidas with PE (n=33) in the first, second and third trimesters. Urinary nephrin concentrations were measured with nephrin enzyme-linked immunosorbent assay kits. RESULTS: The levels of urinary nephrin were higher in gravida developing preeclampsia or SGA than in controls after adjusting serum creatinine (P<0.05 for both). Maternal urine concentrations of nephrin were higher in pregnancies complicated by SGA and PE in the third trimester (P<0.05), and also higher in pregnancies complicated by SGA in the first trimester (P<0.05). The sensitivity and specificity of nephrin in predicting SGA from normal pregnancies were 67% and 89% in the first trimester, 60% and 79% in the second trimester, and 80% and 84% in the third trimester, respectively. The sensitivity and specificity of nephrin in predicting PE from normal pregnancies were 67% and 83% in the first trimester and 73% and 79% in the third trimester, respectively. CONCLUSION: We suggest that urinary nephrin can be used as an early marker in pregnancies at risk for developing PE and SGA infants.