.jpg "Shannon Byler, MD, MPH, photo")
Shannon Byler, MD, MPH,
Critical Care Fellow
Boston Children's Hospital
Boston, Massachusetts
Disclosure information not submitted.
Alexandra Baker, MD
Instructor in Pediatrics
Boston Children's Hospital, United States
Disclosure information not submitted.
Eli Freiman, MD
Attending in Pediatric Emergency Medicine
Boston Children's Hospital
Boston, Massachusetts, United States
Disclosure information not submitted.
Joshua Herigon, MD MPH MBI
Clinical Fellow
Boston Children's Hospital
Boston, Massachusetts, United States
Disclosure information not submitted.
Matthew Eisenberg, MD MPH
Assistant Professor of Pediatrics and Emergency Medicine
Boston Children's Hospital, United States
Disclosure information not submitted.
Title: Utility of Specific Laboratory Biomarkers to Predict Severe Sepsis in Pediatric Patients with SIRS
Objective: To identify the association between readily available laboratory biomarkers and the development of severe sepsis in children presenting to the emergency department (ED) with systemic inflammatory response syndrome (SIRS).
Methods: In this retrospective cohort study, ED patient encounters from June 2018 to June 2019 that triggered an automated sepsis alert based on SIRS criteria were analyzed. Encounters were included if the patient had any of the following laboratory tests sent within 6 hours of ED arrival: lactic acid, white blood cell count (WBC), procalcitonin (PCT), absolute neutrophil count (ANC), platelet count, C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR). For each of the biomarkers, a receiver operating characteristic (ROC) curve was created for our primary outcome, severe sepsis, and our secondary outcome, culture-positive severe sepsis. For each ROC curve, the AUC was calculated with 95% confidence intervals (95% CI) and a table of sensitivity and 1-specificity was used to create cutoff points to achieve 90% sensitivity and 90% sensitivity for our primary and secondary outcomes.
Results: During the study period, 4,349/61,195 (7.1%) encounters triggered an automated sepsis alert. Of those, 1839/4349 (42.4%) had one of the candidate biomarkers sent within 6 hours of ED arrival and were included in the study. A total of 105/1839 (5.7%) met criteria for severe sepsis within 24 hours of arrival, and 44/105 severe sepsis cases (41.9%) were culture positive. Procalcitonin, CRP, and lactic acid had the highest AUCs for identifying severe sepsis [0.62 (0.52-0.73), 0.59 (0.49-0.68), 0.57 (0.49-0.65)], respectively. A procalcitonin value of 2.72 ng/mL was found to have 90% specificity in identifying severe sepsis. A CRP value of 16.79 mg/dL and a lactic acid level of 3.6 mmol/L were found to have 90% specificity in identifying severe sepsis. ESR and CRP were found to have higher AUCs for culture-positive sepsis than the other biomarkers [0.68 (0.47-0.89) and 0.67 (0.53-0.81)].
Conclusion: Our data indicate that procalcitonin, lactic acid, ESR and CRP elevations were specific, but not sensitive, in identifying children in the ED with SIRS who go on to develop severe sepsis.