Diagnostic and prognostic utility of c-reactive protein and serum ferritin in children with suspected sepsis: a cross-sectional observational study.
DOI:
https://doi.org/10.51168/ts8rde05Keywords:
Pediatric Sepsis, C-Reactive Protein, Serum Ferritin, Septic Shock, PrognosisAbstract
Introduction Pediatric sepsis requires rapid recognition despite delayed or negative microbiological cultures. C-reactive protein (CRP) and ferritin are accessible inflammatory biomarkers. This study assessed their diagnostic and prognostic associations with culture positivity, septic shock, PRISM III score, and in-hospital mortality. Materials and Methods This prospective observational study included 40 children with suspected sepsis. Clinical details and cultures were recorded, and serum CRP and ferritin were measured at admission and 48 hours. Disease severity was assessed using septic shock status and PRISM III score, with survival recorded. Diagnostic utility for culture positivity was evaluated using sensitivity, specificity, predictive values and ROC analysis, with appropriate statistical tests and p<0.05 considered significant. Results Among 40 children with suspected sepsis, 37.5% were culture-positive. CRP was significantly higher in culture-positive cases at admission (66.93 ± 22.40 vs 51.88 ± 22.68 mg/L; p=0.048) and 48 hours (98.26 ± 15.83 vs 58.55 ± 22.74; p<0.001), with 48-hour AUC of 0.908. Septic shock was associated with higher CRP (71.23 ± 16.90 mg/L) and ferritin (461.70 ± 262.83 ng/mL). Ferritin was markedly higher among non-survivors (657.20 ± 162.73 vs 218.12 ± 225.54 ng/mL; p<0.001). Both CRP (r=0.507) and ferritin (r=0.543) correlated significantly with PRISM III scores. Conclusion CRP, particularly at 48 hours, demonstrated useful diagnostic performance for culture-positive sepsis, while ferritin showed stronger associations with septic shock and mortality. Both biomarkers correlated significantly with PRISM III scores, supporting CRP as a diagnostic marker and ferritin as a useful indicator of severity and prognosis.Recommendations
Serial CRP measurement can complement clinical and microbiological assessment, while ferritin can assist severity and prognostic stratification. Both should be interpreted with culture findings and PRISM III rather than as standalone tests. Larger prospective studies should validate clinically useful cut-offs.
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Copyright (c) 2026 Dr. Suma C P, Dr . Lingaraju K S, Dr. Kirana Kumar B N (Author)
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