Individual and combined bioscore model of presepsin, procalcitonin, and high sensitive C - reactive protein as biomarkers for early diagnosis of paediatric sepsis

Samuel Asamoah Sakyi; Anthony Enimil; David Kwabena Adu; Richard Dadzie Ephraim; Kwabena Owusu Danquah; Linda Fondjo; David Baidoe-Ansah; Prince Adoba; Emmanuel Toboh; Bright Oppong Afranie

doi:10.1016/j.heliyon.2020.e04841

Individual and combined bioscore model of presepsin, procalcitonin, and high sensitive C - reactive protein as biomarkers for early diagnosis of paediatric sepsis

Heliyon. 2020 Sep 14;6(9):e04841. doi: 10.1016/j.heliyon.2020.e04841. eCollection 2020 Sep.

Affiliations

¹ Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
² Child Health Directorate, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
³ College of Health and Well-Being, Kintampo, Ghana.
⁴ Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
⁵ Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁶ Department of Physiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁷ Laboratory Diagnostics, Ghana Health Service, Dansoman Polyclinic, Accra, Ghana.

Abstract

Background: 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 = 78.7%) followed by hs-CRP (AUC = 78.4%) and sCD14-ST (AUC = 74.8%). Combination of PCT + hs-CRP had the highest accuracy (AUC = 80.1%) followed by hs-CRP + sCD14-ST (AUC = 77.2%), PCT + sCD14-ST + hs-CRP (AUC = 77.0%) and PCT + sCD14-ST (AUC = 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.

Keywords: Bioscore model; High sensitive C-reactive protein; Immunology; Infectious disease; Musculoskeletal system; Paediatric sepsis; Paediatrics; Presepsin; Procalcitonin; Renal system; Reproductive system.