Diagnostic Markers for Identifying Sepsis in Patients with Systemic Inflammatory Response Syndrome (SIRS): A Prospective Study

ABSTRACT

Sepsis caused by infection remains a major cause of mortality and morbidity among children. Several inflammatory markers have failed to meet the requirements for early diagnosis of sepsis. We saw the potential value of measuring the total leukocyte count and the inflammatory markers C reactive protein (CRP), procalcitonin (PCT) and interleukin (IL) 6 in patients with SIRS for early identifying of sepsis. Children with SIRS (n = 52) were included in a prospective study. Changes in the total leukocyte count and levels of inflammatory markers and their inter-correlations were evaluated in SIRS and sepsis patients at different time points. Sepsis was recognized in 21% of the SIRS patients. There was a statistically significant difference between PCT and CRP levels in the SIRS and sepsis patient groups. In patients with sepsis, the IL6 level at the outset of the study had a mean value of 476.68 ± 955.137 pg/ml, which differed significantly from the mean IL6 level in SIRS patients (51.3 ± 137.5 pg/ml). The IL6 level in sepsis patients decreased significantly after 24 hours. We conclude that SIRS and sepsis patients differed significantly in respect of changes in CRP, PCT and IL6 levels. In view of the relatively small number of subjects in the sepsis group we can only suggest that special attention should be paid to SIRS patients with elevated levels of those indicators. A continuing search for specific and sensitive inflammatory markers and their combinations in SIRS patients is required so that sepsis can be diagnosed early enough.