Comparison of Three Biomarkers with Blood Culture Yield in Children with Sickle Cell Anaemia at an Acute Care Tertiary Setting of North-Western Nigeria

Abstract

Background: Most acute presentations of sickle cell anaemia (SCA) mimic sepsis or a systemic inflammatory response syndrome (SIRS), but blood culture results take at least 48-72 hours, and usually of low yield. Therefore, a diagnostic marker differentiating sepsis from other acute presentations in SCA patients is needed. This study describes the performance of blood culture, C-Reactive Protein (CRP), high sensitive CRP (hsCRP) and Procalcitonin (Procal) in an acute care setting.
Methods and Material: Consecutive SCA patients with various acute presentations that attended the Emergency Paediatrics Unit of a tertiary hospital in north-western Nigeria were recruited; and their blood culture, CRP, hsCRP and Procal were evaluated.
Results: There were 25 acutely ill SCA patients recruited, with a mean±std age of 8.6±4.4 years. There were 2(8%), 11(44%) and 12(48%) patients in the category of no SIRS, with SIRS and with sepsis respectively. The means±std of biomarkers were CRP 126.7±62.4mg/L, Procal 4.38±11.6 ng/ml, and hsCRP 5mg/L respectively. Only 5(20%) of the blood cultures yielded growth of bacteria, P value 0.033. One subject in no SIRS group, four in SIRS group and nine in sepsis groups had elevated Procal levels. The CRP and hsCRP values were elevated in all the subjects across the groups, apart from one subject in the SIRS group with a normal CRP. These did not show any statistically significant differences.
All the 5(20%) subjects with positive blood culture had elevated levels of Procal while 9(36%) of the negative blood cultures had elevated Procal levels. This association was significant with a P value 0.026. C-Reactive Protein and hsCRP values were elevated in all blood culture categories, except for one negative culture which had normal CRP.
Conclusions: Procalcitonin performed most comparably to blood culture in differentiating sepsis and SIRS in patients with SCA during acute presentations; better than CRP or hsCRP.