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Aghili N, Sobouti B. Diagnostic Accuracy of Procalcitonin for Distinguishing Between Gram-negative and Gram-positive Sepsis in Pediatric Burn Patients. JGUMS 2025; 34 (3) :322-333
URL: http://journal.gums.ac.ir/article-1-2749-en.html

Background Burn injuries break down skin integrity, increasing the risk of sepsis, a leading cause of morbidity and mortality in burn patients. Rapid differentiation of gram-negative sepsis from Gram-positive sepsis is crucial for timely and effective antibiotic therapy. Serum procalcitonin (PCT) has emerged as a potential biomarker for sepsis differentiation. 
Objective This study aimed to evaluate the diagnostic accuracy of serum PCT for distinguishing between Gram-negative and Gram-positive sepsis in pediatric burn patients.
Methods This cross-sectional study was conducted on 117 pediatric burn patients with positive blood cultures and clinical diagnosis of sepsis based on the American Burn Association criteria. Serum PCT levels were quantified and compared with blood culture results. Diagnostic performance was assessed using the receiver operating characteristic (ROC) curves and determining the optimal cut-off point.
Results Gram-negative bacteria were identified in 60.2% of cases, while gram-positive bacteria were detected in 39.8%. The serum PCT level was significantly higher in gram-negative cases than in gram-positive cases (14.58 ng/mL vs 4.62 ng/mL, P<0.001). An optimal cut-off point of 3.15 ng/mL demonstrated 84.3% sensitivity and 57.4% specificity for detecting gram-negative sepsis. Patients with gram-negative sepsis experienced longer hospital stays, elevated inflammatory markers, higher organ dysfunction, and increased mortality rates (31% vs. 2%, P<0.001) than those with gram-positive sepsis.
Conclusion Serum PCT has moderate sensitivity but low specificity for differentiating gram-negative from gram-positive sepsis in pediatric burn patients. PCT may be used as a valuable adjunct to clinical and laboratory indicators. Larger multicenter studies are recommended to validate these findings and refine diagnostic algorithms for sepsis management.