Acute and Critical Care

Original Articles

Pediatrics
Refining mortality risk stratification in pediatric sepsis: the roles of PELOD-2, vasoactive-inotropic scores, and procalcitonin in a tertiary hospital in Eastern Indonesia: Arya Krisna Manggala, Dyah Kanya Wati, Ida Bagus Gede Suparyatha, I Nyoman Budi Hartawan; Acute Crit Care. 2026;41(2):387-398. Published online April 17, 2026; DOI: https://doi.org/10.4266/acc.002450

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Abstract PDF: Background
Sepsis is a leading cause of mortality and morbidity in children. While the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score is a common predictor of mortality, it does not account for the use of inotropic drugs or sepsis markers, which are addressed by the vasoactive-inotropic score (VIS) and measurements of procalcitonin levels. Combining these components enables faster and more accurate predictions of mortality risks. Therefore, this study aimed to develop a new stratification model of mortality risks by integrating PELOD-2, VIS, and procalcitonin among children with septic shock. Methods: A single-center, three-year, retrospective cohort study was conducted in the pediatric intensive care unit of a tertiary hospital. Children aged 1 month to 18 years and diagnosed with septic shock between 2022 and 2024 received vasoactive and/or inotropic support within 24 hours of diagnosis. PELOD-2 scores and procalcitonin levels were recorded at diagnosis. The cutoff values for PELOD-2, VIS, and procalcitonin were determined using receiver operating characteristic curves. Multivariate analysis was used to generate a final equation and validated with the Hosmer-Lemeshow goodness-of-fit test. Results: A total of 101 children were included, with a mortality rate of 78.2%. The optimal cutoff values were a PELOD-2 score ≥8 (sensitivity, 88.6%; specificity, 72.7%), a VIS score ≥11.5 (sensitivity, 78.5%; specificity, 72.7%), and a procalcitonin level ≥5 ng/ml (sensitivity, 74.7%; specificity, 68.2%). Multivariate analysis revealed significant associations with outcomes: PELOD-2 (adjusted odds ratio [aOR], 12.75; P<0.001), VIS (aOR, 4.686; P=0.02), and procalcitonin (aOR, 4.245; P=0.029). The new mortality risk prediction model achieved a range of 12.8% to 97.39% and exhibited excellent discriminator power (area under the curve, 0.911). The Hosmer–Lemeshow test confirmed good calibration. Conclusions: The new scoring approach that refines stratification of mortality risks by incorporating PELOD-2, VIS, and procalcitonin is a more comprehensive predictor.

Cardiology
Utility of procalcitonin in diagnosing early postoperative sepsis after pediatric cardiac surgery in Malaysia: Muhammad Yusoff Mohd Ramdzan, Kah Kee Tan, Kok Wai Soo; Acute Crit Care. 2025;40(4):567-573. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.005016

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Abstract PDF: Background
Systemic inflammation following cardiopulmonary bypass (CPB) can interfere with analysis of routine clinical and biochemical parameters. Procalcitonin (PCT) is a potential biomarker for diagnosing early postoperative sepsis in pediatric patients following cardiac surgery utilizing CPB. This study aimed to evaluate the diagnostic accuracy of PCT compared to other biomarkers, especially C-reactive protein (CRP), in this clinical setting.
Methods
A prospective single-center study was conducted over a 10-month period during the coronavirus disease 2019 (COVID-19) pandemic (2021–2022), enrolling 89 pediatric patients postcardiac surgery. PCT, CRP, and complete blood count were analyzed, and area under the curve (AUC) was employed for statistical analysis.
Results
PCT and CRP demonstrated moderate discriminatory ability with AUCs of 0.678 and 0.635, respectively. White cell count exhibited fair discriminatory power, and platelet count performed poorly in distinguishing septic from nonseptic cases (AUC: white cell count, 0.545; platelet, 0.486).
Conclusions
PCT and CRP hold promise as diagnostic markers for early postoperative sepsis in pediatric cardiac surgery patients. However, these biomarkers are not adequate standalone indicators, emphasizing the continued need for clinical judgment supported by multiple diagnostic parameters.

Immunology
Serum procalcitonin and C-reactive protein as indices of early sepsis and mortality in North Indian pediatric burn injuries: a prospective evaluation and literature review: Nupur Aggarwal, Durga Karki, Rajni Gaind, Monika Matlani, Vamseedharan Muthukumar; Acute Crit Care. 2024;39(3):350-358. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2023.00759

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2 Web of Science
4 Crossref

Abstract PDF

Background
Delays in diagnosing sepsis in children afflicted with thermal injuries can result in high morbidity and mortality. Our study evaluated the role of the biomarkers Procalcitonin (PCT) and C-reactive protein (CRP) as predictors of early sepsis and mortality, respectively, in this group of patients.
Methods
This was a prospective evaluation of 90 pediatric burn cases treated at a tertiary care burn center in Northern India. Patients, aged 1–16 years, presenting within 24 hours of being burned, with >10% body surface area of burn injury were included in the study. Levels of PCT and CRP were measured on days 1, 3, 5, and 7. Patients were followed until discharge, 30th post-burn day, or death, whichever occurred first.
Results
Sepsis was clinically present in 49 of 90 (54.4%) cases with a median 30% total body surface area (TBSA) of burns. Mortality was seen in 31 of 90 (34.4%) cases with a median of 35% TBSA burns. High PCT and CRP were seen in the sepsis group, particularly on days 3, 5, and 7. PCT was also significantly higher in the mortality group (days 1 and 3).
Conclusions
While PCT was a good early predictor of sepsis and mortality in children with burns, CRP was reliable as a predictor of sepsis only. Both markers, however, can serve as adjuncts to culture sensitivity reports for diagnosing early onset sepsis and initiation of antibiotic therapy in appropriate patients.

Citations

Citations to this article as recorded by

Predictive Value of Inflammatory Burden Index for Sepsis in Critically Ill Patients with Extensive Burns: A Decade-Long Cohort Study
Songwei Zhou, Xin He, Yuqun Huang, Wei Zhu, Huapei Song
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Infectious complications of burns in the intensive care unit
Alain Fennessy, Laura Slattery, Odhran Shelley, Luis Felipe Reyes, Ignacio Martin-Loeches
Journal of Critical Care.2026; 94: 155519. CrossRef
Refining mortality risk stratification in pediatric sepsis: the roles of PELOD-2, vasoactive-inotropic scores, and procalcitonin in a tertiary hospital in Eastern Indonesia
Arya Krisna Manggala, Dyah Kanya Wati, Ida Bagus Gede Suparyatha, I Nyoman Budi Hartawan
Acute and Critical Care.2026; 41(2): 387. CrossRef
Research Progress on Immune Inflammatory Response in Severe Burn and the Treatment with Ulinastatin
祺马
Advances in Clinical Medicine.2025; 15(05): 896. CrossRef

Trauma
C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury: Canan Gürsoy, Güven Gürsoy, Semra Gümüş Demirbilek; Acute Crit Care. 2022;37(3):462-467. Published online August 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00052

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10 Web of Science
10 Crossref

Abstract PDF

Background
Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI.
Methods
Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively.
Results
The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR.
Conclusions
This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

Citations

Citations to this article as recorded by

Performance and accuracy of blood glucose and neutrophil-lymphocyte ratio as predictors of mortality in children and adolescents with traumatic brain injury
José Roberto Tude Melo, Caio Vinicius de Almeida Chaves, Cindy Kawano, Isabela Zampirolli Leal, Maria Antonia Coladeti Fernandes, Stephannie Monaco Bodra, Jean Gonçalves de Oliveira, José Carlos Esteves Veiga
Child's Nervous System.2026;[Epub] CrossRef
Prognostic value of CAR, FIB-4, and procalcitonin in subdural hematoma: associations with mortality and 90-day functional outcomes running title: CAR, FIB-4, and procalcitonin in SDH outcomes
Tamer Tamdoğan, İlke Tamdoğan
Journal of Health Sciences and Medicine.2026; 9(1): 19. CrossRef
One-Year Mortality After Percutaneous Endoscopic Gastrostomy: The Prognostic Role of Nutritional Biomarkers and Care Settings
Nermin Mutlu Bilgiç, Güldan Kahveci, Ekmel Burak Özşenel, Sema Basat
Nutrients.2025; 17(5): 904. CrossRef
Elevation of C-reactive protein and homocysteine levels as reliable biomarkers for assessing injury severity and prognosis in traumatic brain injury
Zi-Yan Wang, Wei Du, Xian-Zhi Liu, Yuan Li, Jun Liu
Scientific Reports.2025;[Epub] CrossRef
Prognostic value of procalcitonin and IL-6 with a composite model in moderate-severe traumatic brain injury
Xin-meng Li, Zi-wei Liu, Wei-yu Liu, Gao-jian Su, Xian-jian Huang
Journal of Clinical Neuroscience.2025; 140: 111516. CrossRef
Development and validation of a prediction model for pulmonary infection in elderly patients with traumatic brain injury
Shuai Tian, Ali Shang, Wenqian Zhou, Zhen Xu, Yunpeng Kou, Zhenyu Guo, Fan Chen, Peigang Ji, Yulong Zhai, Wenjian Zhao, Yang Jiao, Zhipeng Song, Shunnan Ge, Yuan Wang, Liang Wang, Shaochun Guo
Neurochirurgie.2025; 71(6): 101733. CrossRef
Albuminemia as a Potential Predictor of Clinical Outcomes in Patients with Severe Traumatic Brain Injury (TBI)
Luka Stepanovic, Usha Govindarajulu, George Agriantonis, Navin D. Bhatia, Jasmine Dave, Shalini Arora, Zahra Shafaee, Kate Twelker, Jennifer Whittington, Bharti Sharma
Journal of Clinical Medicine.2025; 14(21): 7499. CrossRef
Research Advances in CAR, NLR, and S100β for Assessing Neurological Functional Prognosis in Traumatic Brain Injury Patients
明隆陈
Advances in Clinical Medicine.2025; 15(10): 2518. CrossRef
Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury
Kathryn S. Gerber, Gemayaret Alvarez, Arsham Alamian, Victoria Behar-Zusman, Charles A. Downs
Journal of Trauma Nursing.2024; 31(2): 72. CrossRef
Association of C-reactive protein/albumin ratio with mortality in patients with Traumatic Brain Injury: A systematic review and meta-analysis
Yuyang Liu, Yaheng Tan, Jun Wan, Qiwen Chen, Yuxin Zheng, Wenhao Xu, Peng Wang, Weelic Chong, Xueying Yu, Yu Zhang
Heliyon.2024; 10(13): e33460. CrossRef

The Utility of Serum Procalcitonin Levels in the Management of Systemic Inflammatory Response Syndrome in the Emergency Department: Kyung Hye Park, Kang Hyun Lee, Kyoung Chul Cha, Hyun Kim, Sung Oh Hwang; Korean J Crit Care Med. 2012;27(1):10-15.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.10

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Abstract PDF: BACKGROUND
The aim of this study was to investigate whether obtaining serum procalcitonin (PCT) levels in patients with systemic inflammatory response syndrome (SIRS) helps the differential diagnosis between sepsis and non-sepsis and predicts disease severity in the emergency department (ED).
METHODS
This prospective study enrolled 132 consecutive adult patients with SIRS who visited the ED. Serum C-reactive protein (CRP) levels and serum PCT levels were compared between sepsis and non-sepsis groups upon ED admission. Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score (MODS), and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were calculated, and their correlations with CRP and PCT levels were evaluated. The PCT and CRP levels were assessed to predict sepsis in terms of comparing receiver operating characteristic (ROC) curves.
RESULTS
Eighty patients were included in the sepsis group. The levels of PCT and CRP in the sepsis group were significantly higher. In the sepsis group, the initial serum PCT correlated with the SOFA and MODS scores, and this also correlated in the non-sepsis group, but CRP did not. No differences were found when the PCT and CRP ROCs were compared.
CONCLUSIONS
Correlation between PCT and severity in the non-sepsis group is considered to be clinically meaningless because of low levels. Additionally, PCT levels had similar diagnostic value for sepsis as CRP levels. PCT is recommended for prediction of severity in sepsis patients in ED, but not for differential diagnosis between sepsis and non-sepsis.

Procalcitonin as a Prognosis Marker for the Severe Sepsis and Septic Shock Patients in Emergency Department: Seung Woon Choi, Hoon Kim, Kyung Hwan Kim, Dong Wun Shin, Jun Seok Park, Jun Young Roh, Jun Min Park; Korean J Crit Care Med. 2011;26(4):250-255.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.250

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1 Crossref

Abstract PDF

BACKGROUND
Advance in sepsis management has increased the survival of patients with sepsis. However, severe sepsis and septic shock patients still have high mortality. We intend to verify the use of the procalcitonin (PCT) level as a prognosis marker in patients with severe sepsis or septic shock in the emergency department (ED).
METHODS
ED Patients with severe sepsis or septic shock were enrolled in our study. We used mortality and Intensive Care Unit (ICU) days as a prognosis index, and compared the PCT level in survivors and non-survivors. We introduced the simplified acute physiology score 3(SAPS3) to assess the severity of the patients and analyzed whether or not the PCT level correlated with the severity index.
RESULTS
The PCT level in septic shock patients [7.36 (0.92-33.69, IQR)] was higher than that in severe sepsis patients [3.24 (0.36-10.53, IQR)] (p = 0.04). However, there was no significant PCT level difference between survivors [median (IQR), 6.59 (0.60-29.25)] and non-survivors [median (IQR), 3.49 (0.40-20.41)] (p = 0.293). The SAPS3 score was higher in the non-survivor group [median (IQR), 64 (59.0-71.5)] than in the survivor group [median (IQR), 77 (68.5-82.0)] (p = 0.001). The PCT level did not correlate with either ICU days or hospital days.
CONCLUSIONS
Using the PCT level as a prognosis factor in severe sepsis and septic shock patients in ED has little value.

Citations

Citations to this article as recorded by

Procalcitonin as a prognostic marker for sepsis: a prospective observational study
Saransh Jain, Sanjeev Sinha, Surendra K Sharma, J C Samantaray, Praveen Aggrawal, Naval Kishore Vikram, Ashutosh Biswas, Seema Sood, Manish Goel, Madhuchhanda Das, Sreenivas Vishnubhatla, Nawaid Khan
BMC Research Notes.2014;[Epub] CrossRef

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