Prognostic value of procalcitonin in children with meningococcal sepsis

Objective: To compare procalcitonin, lactate, and C-reactive protein as prognostic markers in children with meningococcal septic shock. Design: Prospective observational study. Setting: Alder Hey Children's Hospital, Liverpool, UK. Patients: Children admitted to our hospital during a 16-month period with a diagnosis of meningococcal sepsis. Results: Plasma procalcitonin at admission was significantly higher in children with septic shock (median, 73.80 vs. 16.44 ng/mL), those requiring ventilation (median, 47.02 vs. 12.00 ng/mL), and those with a duration of hospital stay >10 days (median, 131.35 vs. 19.26 ng/mL). Both procalcitonin and lactate reliably discriminated between those children with septic shock (area under the curve [AUC] = 0.85 and 0.84, respectively) and durations of hospital stay exceeding 10 days (AUC = 0.87 and 0.79, respectively) and those without, but C-reactive protein did not. Procalcitonin alone reliably discriminated between those children requiring ventilation and these who did not (AUC = 0.72). Conclusion: Procalcitonin is a reliable prognostic marker of septic shock, requirement for ventilation, and prolonged hospital stay in children with meningococcal sepsis and performs better than lactate and C-reactive protein.