C-reactive protein ratio response patterns in pediatric sepsis: a cohort study - preliminary results

Methods This is a multicenter prospective descriptive cohort of children (1 month-old to 18 year old) admitted at PICUs of 3 tertiary hospitals in Rio de Janeiro, Brazil, with sepsis diagnosis (< 72 hours). CRP was sampled every other day from D0 to D6 of PICU stay. CRP-ratio was calculated in relation to D0 CRP concentration. Patients were classified according to an individual pattern of CRP-ratio response with the following criteria: fast response when D4 CRP was less than or equal to 0.4 of D0 CRP concentration; slow response when D4 CRP was > 0.4 and D6 less than or equal to 0.8 of D0 CRP concentration (continuous and slow response); nonresponse when D6 CRP was > 0.8 of D0 CRP concentration; biphasic response characterized by an initial CRP decrease to levels < 0.8 of the D0 CRP followed by a secondary rise > 0.8. Comparison between ICU survivors and non-survivors was performed. Results Preliminary results of this cohort included 57 patients (age median: 1.6; 56,1% male); the most frequent sites of infection were lung 54,4%, central nervous system 14%, abdominal 7%. Out of the 57 patients, 50 could be classified according to a predefined pattern: N=15 fast response, N=23 slow response, N=5 nonresponse and N=7 biphasic response. The ICU mortality rate was significantly different according to the patterns of CRP-ratio response: fast response 6,7%, slow response 4,3%, nonresponse 40% and biphasic response 42,9% (p < 0.001). The time dependent analysis of CRP-ratio course of the different patterns was significantly different (p < 0.001).