Prognostic value of elevated SLPI levels for early detection of sepsis in children with community-acquired pneumonia

Sepsis is one of the most serious complications of community-acquired pneumonia in school-aged children, requiring early diagnosis and risk stratification. Although the Phoenix Sepsis Score has been introduced to assess organ dysfunction, its sensitivity during the first hours of hospitalization remains limited. Evaluating the serum level of secretory leukocyte protease inhibitor (SLPI) as an additional sepsis biomarker may enhance early identification of severe infection. Аim - to determine the prognostic significance of serum SLPI levels for the early detection of sepsis in children with community-acquired pneumonia. Materials and methods. A total of 135 children aged 5–18 years with bacterial community-acquired pneumonia were examined. Sepsis was assessed using the Phoenix Score (≥2 points indicating sepsis). SLPI levels were measured by ELISA and stratified by quartiles. Statistical analysis included the χ² test, logistic regression, and ROC analysis (AUC, ΔAUC), with adjustment for age, sex, and disease severity. Results. Sepsis was identified in one-third of patients within the first 24 hours of hospitalization. In the fourth SLPI quartile, the proportion of sepsis reached 50%, compared to only 20.6% in the first quartile. Elevated SLPI levels were associated with increased sepsis risk. Adding SLPI to the baseline model of routine inflammatory markers increased the AUC from 0.65 to 0.69, and sensitivity from 21% to 67%. In the final model, only elevated SLPI and D-dimer levels remained independent prognostic markers. Conclusions. Elevated SLPI levels in children with community-acquired pneumonia represent an independent risk marker for sepsis and enhance the predictive accuracy of screening models. SLPI determination should be considered for inclusion in standard laboratory monitoring during the first day of hospitalization. This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent was obtained from all patients (parents or legal guardians). The authors declare no conflict of interest.