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Background <p>Continuous renal replacement therapy (CRRT) may influence biomarker levels through extracorporeal clearance, complicating their interpretation in critically ill children. This study aimed to characterize the early kinetics of procalcitonin (PCT) and C-reactive protein (CRP) during the first 24&#xa0;h after CRRT initiation and to evaluate their association with PICU mortality in critically ill children.</p> Methods <p>This retrospective observational study included 152 critically ill pediatric patients undergoing CRRT. PCT and CRP levels were measured at CRRT initiation (T0) and at 24&#xa0;h after CRRT initiation (T24). Biomarker clearance was calculated as the percentage change from T0 to T24. Disease severity was assessed using the Pediatric Risk of Mortality III (PRISM-III) score and vasoactive–inotropic score (VIS). Associations with mortality were analyzed using logistic regression, and predictive performance was evaluated using receiver operating characteristic (ROC) analysis.</p> Results <p>PICU mortality was 36.8%. PCT levels were higher in non-survivors at CRRT initiation and at 24&#xa0;h after CRRT initiation, with a more pronounced difference at 24&#xa0;h (<i>p</i> = 0.017 and <i>p</i> &lt; 0.001, respectively). PCT levels decreased significantly only in survivors. CRP levels showed no significant early changes in either group. PCT at 24&#xa0;h after CRRT initiation demonstrated modest discriminative ability for mortality (AUC = 0.663), whereas CRP parameters showed lower performance. In multivariable analysis, VIS T24 and PRISM-III score remained independent predictors of mortality, while PCT did not retain independent significance.</p> Conclusions <p>Early PCT and CRP kinetics during the first 24&#xa0;h after CRRT initiation showed limited standalone prognostic value. PCT levels at 24&#xa0;h were associated with mortality in unadjusted analyses, but their discriminatory performance was modest and they should be interpreted only as supportive biomarkers within the broader clinical context rather than as alternatives to established severity scores.</p>

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Early changes in procalcitonin and C-reactive protein during continuous renal replacement therapy and their association with mortality in critically ill children: a retrospective observational study

  • 期刊论文

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  • 发表日期：

    2026年7月14日

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  • Kubra Boydag Guvenc,
  • Ebru Guney Sahin,
  • Sirin Guven,
  • Fatih Varol,
  • Cansu Durak

摘要

Background

Continuous renal replacement therapy (CRRT) may influence biomarker levels through extracorporeal clearance, complicating their interpretation in critically ill children. This study aimed to characterize the early kinetics of procalcitonin (PCT) and C-reactive protein (CRP) during the first 24 h after CRRT initiation and to evaluate their association with PICU mortality in critically ill children.

Methods

This retrospective observational study included 152 critically ill pediatric patients undergoing CRRT. PCT and CRP levels were measured at CRRT initiation (T0) and at 24 h after CRRT initiation (T24). Biomarker clearance was calculated as the percentage change from T0 to T24. Disease severity was assessed using the Pediatric Risk of Mortality III (PRISM-III) score and vasoactive–inotropic score (VIS). Associations with mortality were analyzed using logistic regression, and predictive performance was evaluated using receiver operating characteristic (ROC) analysis.

Results

PICU mortality was 36.8%. PCT levels were higher in non-survivors at CRRT initiation and at 24 h after CRRT initiation, with a more pronounced difference at 24 h (p = 0.017 and p < 0.001, respectively). PCT levels decreased significantly only in survivors. CRP levels showed no significant early changes in either group. PCT at 24 h after CRRT initiation demonstrated modest discriminative ability for mortality (AUC = 0.663), whereas CRP parameters showed lower performance. In multivariable analysis, VIS T24 and PRISM-III score remained independent predictors of mortality, while PCT did not retain independent significance.

Conclusions

Early PCT and CRP kinetics during the first 24 h after CRRT initiation showed limited standalone prognostic value. PCT levels at 24 h were associated with mortality in unadjusted analyses, but their discriminatory performance was modest and they should be interpreted only as supportive biomarkers within the broader clinical context rather than as alternatives to established severity scores.