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Procalcitonin is associated with sudden unexpected death in infancy due to infection

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Abstract

Infection is an important cause of death during infancy worldwide and is a frequent etiology of sudden unexpected death in infancy (SUDI). Procalcitonin (PCT) is a useful marker to diagnose infection in patients, and several studies report the stability of PCT after death. The added value of a biological marker, such as the PCT level in the blood, remains controversial in investigating SUDI. The aim of this study was to determine if PCT can help clinicians determine whether infection caused SUDI. We conducted a retrospective, multicenter study with the French SUDI registry (Observatoire National des Morts Inattendues du Nourrisson; OMIN). We collected data from this registry on children who died between May 2015 and June 2021. The levels of PCT in the blood of 540 SUDI patients were measured. We compared PCT and other biological tests performed in terms of infection status, autopsy results, and cause of death using clinical and biological data compiled by pediatricians at the SUDI referral center. PCT levels were significantly higher in the children who died from infection than in those who did not (0.12 µg/L vs. 0.08 µg/L, p < 0.001). A PCT blood level exceeding 0.2 µg/L was more frequently observed when infection was present than in the absence of infection (44.3% vs. 15.4%, p < 0.001). The same data were obtained with a 0.5 µg/L cut-off (36.1% with infection vs. 9.2% without, p < 0.001).

  Conclusions: PCT is a sensitive biomarker for detecting infections postmortem; thus, additional samples may be necessary during autopsy.

What is known:

• PCT is a stable marker postmortem and increases earlier than CRP, i.e., 2–4 h after the beginning of an infection vs. 6 h.

• PCT can be measured up to 140 h after death.

What is new:

• PCT is a sensitive marker for detecting infection in SUDI patients postmortem.

• This test can reveal an infection from non-standardized samples obtained during autopsy if such an infection was not determined before death.

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Acknowledgements

We thank the families affected by SUDI as well as the participating centers. We also are grateful to the OMIN study group for the data.

Author information

Authors and Affiliations

  1. Pediatric Emergency Department, Children’s Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France

    Maritie Collette, Mathilde Hauet & Anne Borsa

  2. Pediatric Department, Children’s Hospital, Children’s Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France

    Cyril Schweitzer

  3. DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, 3450, Vandœuvre-Les-Nancy, EA, France

    Cyril Schweitzer

  4. EDPFM, Univ Montpellier, CHU Montpellier, Service de Médecine Légale, Montpellier, France

    Laurent Martrille

  5. Pediatric Intensive Care Unit, Children’s Hospital, University Hospital of Nancy, C.H.R.U. Nancy, 54500, Vandoeuvre-Les-Nancy, France

    Arnaud Wiedemann

  6. University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France

    Arnaud Wiedemann

  7. Inserm, Clinical Investigation Centre 1413, University Hospital of Nantes, Nantes, France

    Sophie de Visme

  8. Université de Lorraine, CHU Nancy, Service de Médecine Légale, 54000, Nancy, France

    Elodie Marchand

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  1. Maritie Collette
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Contributions

Author Contributions: All authors contributed to the study's conception and design. Material preparation, data collection and analysis were performed by M.C., M.H. and A.W.. M.C. and A.W. wrote the first draft of the manuscript, and all authors commented on the previous versions. All authors read and approved the final manuscript.

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Correspondence to Arnaud Wiedemann.

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Communicated by Daniele De Luca

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Collette, M., Hauet, M., de Visme, S. et al. Procalcitonin is associated with sudden unexpected death in infancy due to infection. Eur J Pediatr 182, 3929–3937 (2023). https://doi.org/10.1007/s00431-023-05064-3

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