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Procalcitonina como marcador de sepsis en niños
Procalcitonin as a Biomarker for Sepsis in Children
Palabras clave:
Biomarcadores, Infección, Sepsis, Lactantes, Niños (es)Procalcitonin, Cultures, Infection, Sepsis, Children (en)
Introducción. La procalcitonina es un biomarcador de infección bacteriana severa y sepsis, con aplicación diagnóstica, para severidad y pronóstico, el cual muestra valores de sensibilidad, especificidad y puntos de corte variables en niños.
Materiales y métodos. Estudio retrospectivo, observacional y descriptivo. Se incluyeron niños de 7 días a 18 años, a quienes se les tomó procalcitonina y cultivo el mismo día. Se evaluaron otros biomarcadores como proteína C reactiva y los datos se tomaron de la historia clínica por medio de un formulario.
Resultados. Se incluyeron 274 muestras de procalcitonina y cultivos, correspondientes a 162 pacientes con edad promedio de 1.5 años —59% masculinos—. De los 274 cultivos, el 81% fueron hemocultivos, siendo positivos el 17%. La procalcitonina con punto de corte >0.5ng/ml mostró sensibilidad de 76%, especificidad de 46%, VPP de 23% y VPN de 90% para sepsis, con AUC 0.6899 (IC95%: 0.6059-0.774). Se encontró de forma estadísticamente significativa que a mayor valor de procalcitonina mayor mortalidad (p=0.003). La procalcitonina mostró mejor rendimiento que los otros biomarcadores para predecir sepsis.
Conclusión. La procalcitonina tiene un buen rendimiento diagnóstico como marcador de sepsis en niños —con mayor utilidad cuando toma valores negativos— y buen valor pronóstico al relacionarse con mortalidad.
Background. Procalcitonin is a biomarker of severe bacterial infection and sepsis, with diagnostic, monitoring, severity and prognosis applications, that shows values of sensitivity, specificity and variable cutoff in children.
Materials and Methods. Retrospective, observational and descriptive study. Patients from 7 days to 18 years old who were taken procalcitonin and cultures on the same day were included. Other biomarkers such as C-reactive protein were assessed. Data were taken from their medical records using an electronic formulary.
Results. 274 samples of procalcitonin and cultures were included, corresponding to 162 patients, 59% male, aged 19 days to 13 years (mean=1.5 years). The most common diagnosis was bacterial pneumonia (39%). Of the 274 cultures, 81% were blood cultures, of which 17% were positive. Procalcitonin with cutoff>0.5ng/ml showed sensitivity of 76%, specificity of 46%, PPV 23%, NPV 90% for sepsis, with an AUC 0.6899 (95% CI 0.6059 to 0774). Greater mortality with high values of procalcitonin (p=0.003) was found. Procalcitonin showed better performance than C-reactive protein, leukocyte and neutrophil count for sepsis prediction.
Conclusion. Procalcitonin has a good diagnostic performance as a marker of sepsis in children —with a higher usefulness with negative values— and has a good prognostic value for mortality.
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Derechos de autor 2016 Revista de la Facultad de Medicina
Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.
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