Serum Procalcitonin and C - reactive protein as Predictors of Severity and Outcomes in Pediatric Sepsis. A Cross-Sectional Clinical Study

Abstract

Background: Sepsis in children is a major cause of morbidity and mortality globally, especially in low- and middle-income countries where its early detection is challenging. Serum procalcitonin (PCT) and C-reactive protein (CRP) are now being used to determine disease severity and outcomes.

Aim: The aim of this study is to determine the diagnostic value of serum procalcitonin and C-reactive protein in the assessment of disease severity and prognosis of children with sepsis.

Methods: A cross-sectional study was conducted at Ghurki Trust Teaching Hospital, Lahore, Pakistan, from June 2023 to June 2025. One hundred children (1 month to 12 years) with sepsis were included. On admission, serum concentrations of PCT and CRP were determined. The severity of the disease and the outcome (recovery without complications, recovery with complications, and death) were used to categorise patients. Data were analysed with SPSS software version 26 (p-value < 0.05).

Results: Both biomarkers demonstrated significantly higher values in patients with severe sepsis compared to those with non-severe disease (PCT: 9.12 ± 2.36 vs 3.28 ± 1.21 ng/mL; CRP: 88.67 ± 17.54 vs 44.92 ± 13.18 mg/L; p<0.001). The highest levels were found in the group of patients who died (PCT: 11.02 ± 2.87 ng/mL; CRP: 94.67 ± 18.33 mg/L). Procalcitonin levels greater than 5 ng/mL were significantly associated with mortality (OR = 3.92, p<0.001), while a CRP level greater than 60 mg/L was significantly associated with complications (OR = 2.76, p=0.003).

Conclusion: Serum procalcitonin is a good predictor of severity and mortality, whereas C-reactive protein is more related to complications. The integration of these biomarkers may help to predict the risk of complications and guide management strategies in children with sepsis.