• Vanessa Soares Lanziotti, Pedro Póvoa, Arnaldo Prata-Barbosa, Lucas Berbet Pulcheri, Rabello Ligia S C F LSCF D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Internal Medicine, Federal University of Rio de Ja, José Roberto Lapa E Silva, Marcio Soares, and Salluh Jorge I F JIF D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Internal Medicine, Federal University of Rio de Janeir.
• D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Internal Medicine, Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro - UFRJ), Rio de Janeiro, RJ, Brazil; Institute of Pediatrics and Child Care Martagão Gesteira, Pediatric Intensive Care Unit, Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro- UFRJ), Rio de Janeiro, RJ, Brazil. Electronic address: vslanziotti@gmail.com.
• J Crit Care. 2018 Apr 1; 44: 217-222.

PurposeEvaluate sequential C-reactive protein (CRP) measurements and patterns of CRP-ratio response to antibiotic therapy during first 7days in Pediatric Intensive Care Unit (PICU) of septic children.MethodsProspective, cohort study of children (1month-12years) admitted at 3 PICUs, with diagnosis of sepsis with <72h course. CRP-ratio was calculated in relation to D0_CRP value. Children were classified according to an individual pattern of CRP-ratio response: fast - CRP_D4 of therapy was <0.4 of D0_CRP; slow - continuous but slow decrease of CRP; non - CRP remained ≥0.8 of D0_CRP; biphasic - initial CRP decrease to levels <0.8 of D0_CRP followed by secondary rise ≥0.8.Results103 septic children (age-median: 2yrs; 54% male) were prospectively included (infection focus: 65% respiratory, 12.5% central nervous system). Overall PICU mortality was 11.7%. 102 children could be classified according to a predefined CRP-ratio response pattern. Time-dependent analysis of CRP-ratio and CRP course of the different patterns were significantly different. Besides, PICU mortality rate was significantly different according CRP-ratio response patterns: fast response 4.5%; slow response 5.8%; non-response 29.4%; biphasic response 42.8%.ConclusionsIn pediatric sepsis, CRP-ratio serial evaluation was useful in early identification of patients with poor outcome.Copyright © 2017 Elsevier Inc. All rights reserved.

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