Early changes in white blood cell, C-reactive protein and procalcitonin levels in children with severe multiple trauma

doi:10.5847/wjem.j.1920-8642.2022.093

Abstract

Abstract:

BACKGROUND: To analyze early changes in white blood cells (WBCs), C-reactive protein (CRP) and procalcitonin (PCT) in children with multiple trauma, before secondary inflammation develops.

METHODS: This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit (PICU). According to the prognostic outcome of 28 d after admission to the PICU, patients were divided into survival group (n=141) and non-survival group (n=36). Characteristics between the two groups were compared. Receiver operation characteristic (ROC) curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.

RESULTS: The percentages of children with elevated WBC, CRP, and PCT levels were 81.36%, 31.07%, and 95.48%, respectively. Patients in the non-survival group presented a statistically significantly higher injury severity score (ISS) than those in the survival group: 37.17±16.11 vs. 22.23±11.24 (t=6.47, P<0.01). WBCs were also higher in non-survival group than in the survival group ([18.70±8.42]×10⁹/L vs. [15.89±6.98] ×10⁹/L, t=2.065, P=0.040). There was no significant difference between the survival and non-survival groups in PCT or CRP. The areas under the ROC curves of PCT, WBC and ISS for predicting 28-day mortality were 0.548 (P=0.376), 0.607 (P=0.047) and 0.799 (P<0.01), respectively.

CONCLUSIONS: Secondary to multiple trauma, PCT levels increased in more patients, even if their WBC and CRP levels remained unchanged. However, early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.

Key words: Pediatric, Procalcitonin, Injury severity score, Multiple trauma

Cai-fang Xu, Ming-chao Huo, Jin-hui Huang, Chun-feng Liu, Wei Xu. Early changes in white blood cell, C-reactive protein and procalcitonin levels in children with severe multiple trauma[J]. World Journal of Emergency Medicine, 2022, 13(6): 448-452.

Figures/Tables 4

Table 1.

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Figure 1.

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Characteristic	Values
Age, months	38 (12.00-83.50)
Gender (male)	101 (57.06)
Death	36 (20.34)
WBC, ×10⁹/L	16.46±7.36
PLT, ×10⁹/L	258.81±92.17
CRP, mg/L	4.29 (2.31-9.72)
PCT, ng/mL	1.74 (0.43-4.65)
GCS≤8	71 (40.11)
ISS	25.23±13.73
TIC	22 (12.43)
Respiratory failure	44 (24.86)
Shock	18 (10.17)
MODS	7 (3.95)

Regions	Injured patients		Non-injured patients		P-value
Regions	n (%)	PCT level, ng/mL	n (%)	PCT level, ng/mL	P-value
Brain	146 (82.49)	1.77 (0.40-4.64)	31 (17.51)	1.66 (0.59-4.77)	0.638
Face	30 (16.95)	3.60 (0.71-7.60)	147 (83.05)	1.54 (0.38-3.65)	0.02
Chest	106 (59.89)	2.31 (0.74-5.99)	71 (40.11)	0.90 (0.24-2.85)	<0.01
Abdomen	40 (22.60)	3.20 (1.09-8.50)	137 (77.40)	1.46 (0.38-3.78)	<0.01
Extremities	59 (33.33)	2.41 (0.72-5.67)	118 (66.67)	1.34 (0.32-3.85)	0.011
Surface	35 (19.77)	2.52 (0.72-4.77)	142 (80.23)	1.56 (0.39-4.64)	0.202

Variables	Survival group (n=141)	Non-survival group (n=36)	t/U/χ²value	P-value
ISS	22.23±11.24	37.17±16.11	6.47	<0.01
PCT, ng/mL	1.66 (0.40-4.87)	1.94 (0.83-3.63)	1.32	0.194
WBC,×10⁹/L	15.89±6.98	18.70±8.42	2.065	0.040
CRP, mg/L	4.34 (2.33-9.99)	3.34 (1.38-8.02)	0.106	0.916
GCS	11.29±3.82	5.83±3.17	7.905	<0.01
Shock	4 (2.84)	14 (38.89)	40.802	<0.01
TIC	12 (8.51)	10 (27.78)	9.781	0.002

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