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Procalcitonin does discriminate between sepsis and systemic inflammatory response syndrome
  1. R Arkader1,
  2. E J Troster2,
  3. M R Lopes4,
  4. R R Júnior1,
  5. J A Carcillo5,
  6. C Leone3,
  7. T S Okay1
  1. 1Laboratory of Medical Investigation–LIM/36–Department of Pediatrics, School of Medicine, University of São Paulo, Brazil
  2. 2Pediatric Intensive Care Unit–“Instituto da Criança do Hospital das Clínicas”, School of Medicine, University of São Paulo, Brazil
  3. 3NuCAMPE–“Núcleo de Consultoria e Apoio em Metodologia de Pesquisa e Estatística do Instituto da Criança–Hospital das Clínicas”, São Paulo, Brazil
  4. 4Department of Anestesiology, “Instituto do Coração do Hospital das Clínicas”–School of Medicine, University of São Paulo, Brazil
  5. 5Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  1. Correspondence to:
    Dr T S Okay
    Laboratório de Investigação Médica–LIM/36–Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647, 05403-900 São Paulo–SP Brazil; tsokay{at}


Aims: To evaluate whether procalcitonin (PCT) and C reactive protein (CRP) are able to discriminate between sepsis and systemic inflammatory response syndrome (SIRS) in critically ill children.

Methods: Prospective, observational study in a paediatric intensive care unit. Kinetics of PCT and CRP were studied in patients undergoing open heart surgery with cardiopulmonary bypass (CPB) (SIRS model; group I1) and patients with confirmed bacterial sepsis (group II).

Results: In group I, PCT median concentration was 0.24 ng/ml (reference value <2.0 ng/ml). There was an increment of PCT concentrations which peaked immediately after CPB (median 0.58 ng/ml), then decreased to 0.47 ng/ml at 24 h; 0.33 ng/ml at 48 h, and 0.22 ng/ml at 72 h. CRP median concentrations remained high on POD1 (36.6 mg/l) and POD2 (13.0 mg/l). In group II, PCT concentrations were high at admission (median 9.15 ng/ml) and subsequently decreased in 11/14 patients who progressed favourably (median 0.31 ng/ml). CRP levels were high in only 11/14 patients at admission. CRP remained high in 13/14 patients at 24 h; in 12/14 at 48 h; and in 10/14 patients at 72 h. Median values were 95.0, 50.9, 86.0, and 20.3 mg/l, respectively. The area under the ROC curve was 0.99 for PCT and 0.54 for CRP. Cut off concentrations to differentiate SIRS from sepsis were >2 ng/ml for PCT and >79 mg/l for CRP.

Conclusion: PCT is able to differentiate between SIRS and sepsis while CRP is not. Moreover, unlike CRP, PCT concentrations varied with the evolution of sepsis.

  • CPB, cardiopulmonary bypass
  • CRP, C reactive protein
  • PCT, procalcitonin
  • POD, post-operation day
  • SIRS, systemic inflammatory response syndrome
  • procalcitonin (PCT)
  • C reactive protein (CRP)
  • cardiopulmonary bypass (CPB)
  • systemic inflammatory response syndrome (SIRS)
  • sepsis

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  • Funding: this research was supported by Brahms Diagnostica GmbH, represented by Analyse and later by Fanem laboratories, in Brazil

  • Published Online First 2 December 2005

  • Competing interests: none declared