Abstract
BACKGROUND: Sepsis is one of the leading causes of morbidity and mortality in children. The aim of our study was to compare the procalcitonin-to-albumin ratio (PAR) and C-reactive protein(CRP)-to-albumin ratio (CAR) in predicting sepsis and its severity in children and to know which one is better. METHODS: This prospective observational study was conducted in a tertiary care hospital from July 2022 to January 2024. Procalcitonin, CRP, and albumin, along with baseline investigations, were sent on the day of admission (day 0), day 2 of admission, and day 7 of admission for all the children with suspected sepsis. RESULTS: This study included 118 children diagnosed with sepsis who were analyzed. Among them, 83 (70%) were male. The median age was 11 years, with a range of two months to 17 years. The median duration of fever prior to hospitalization was four days. The mortality and morbidity distribution included total septic shock in 22 (19%), multiple organ dysfunction (MODS) in 12 (9%), and death in 13 (11%). In total, 22 (19 %) patients required inotropic support, and 15 (13 %) required respiratory support. The cut-off value for predicting sepsis obtained for PAR was 13.5 with sensitivity 49.47% and specificity 95.61% on the day of admission, whereas the cut-off value for CAR was 0.31 with sensitivity 67.36% and specificity 64.21% on the day of admission. Receiver-operating characteristic (ROC) curve analysis was done for the diagnostic value of PAR and CAR, and the area under the curve (AUC) for detecting sepsis were 0.73 (95%CI=0.634-0.827) and 0.67 (95% CI=0.544-0.796), respectively. CONCLUSION: The study demonstrates that the PAR and CAR are valuable diagnostic markers for predicting sepsis in children. On the day of admission, PAR showed a higher specificity (95.61%) compared to CAR (64.21%), making it a reliable marker for ruling in sepsis, while CAR exhibited greater sensitivity (67.36%) for detecting cases. The ROC curve analysis revealed AUC values of 0.73 for PAR and 0.67 for CAR, indicating moderate diagnostic accuracy for both. These findings suggest that PAR and CAR can complement traditional markers in diagnosing pediatric sepsis and its severity, with PAR being particularly useful in identifying more severe cases. Further research is warranted to validate these markers and explore their prognostic utility over time.