Abstract
Background: Despite improvements in the understanding of pathophysiology and new treatment options for sepsis, the mortality rate continues to be elevated. It is often difficult to distinguish critically ill patients with sepsis, organ dysfunction or shock from patients with similar clinical signs and laboratory findings without infections. Procalcitonin (PCT) has been proposed as an effective indicator of infection and as a useful marker of the severity of sepsis. The aim of this study was to evaluate serum PCT in critically ill patients admitted with suspected sepsis.
Methods: Prospective study conducted over a period of one year, a total of 150 critically ill patients with suspected sepsis were included. Serum procalcitonin level was assessed on 1st day, 3rd day and 7th day of illness.
Results: PCT was positive in 92% of cases, blood culture was positive in 34.67% of cases, statistically significant correlation of PCT with blood culture positivity (p<0.05). PCT positivity rate and mean PCT level decreased with time as sepsis got treated. Significantly higher mean PCT in culture positive sepsis and among these in bacterial sepsis. PCT kinetics was found to be of prognostic value from day 3 of sepsis. ROC analysis revealed maximum sensitivity of 98.08% and a specificity of 38.77%, positive predictive value (PPV) 45.94% and negative predictive value (NPV) 91.67% with a PCT value of 0.31 ng/ml.
Conclusions: PCT may direct physicians in their clinical decision making and their stepwise approach to the complex management of critically ill patients with sepsis. It has diagnostic as well as prognostic significance. The addition of PCT to the standard work up of critically ill patients with suspected sepsis might assist in avoiding unwanted antibiotic usage in patients who presents with symptoms similar to infective conditions.
Keywords: Procalcitonin, blood culture, critically ill, sepsis, PCT cut off.
References
- Biffl WL, Moore EE, Moore FA, Peterson VM. Interleukin- 6 in the injured patient. Marker of injury or mediator of inflammation? Ann Surg 1996; 224: 647-64. Biffl WL, Moore EE, Moore FA, Peterson VM. Interleukin- 6 in the injured patient. Marker of injury or mediator of inflammation? Ann Surg 1996; 224: 647-64.
- Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonatal 2004; 89: F229-F235.
- Nanda SK, Dinakaran A, Bhat S. Diagnostic and prognostic role of Procalcitonin in sepsis in a tertiary care hospital. Biomedical Research 2016; 27 (1): 79-83
- Sharma R, Vijayakumar M. Procalcitonin for improved assessment and an answer to sepsis dilemma in critically ill-a myth, a hype, or a reality?.Nitte University Journal of Health Science. 2014 Mar 1;4(1).
- Lopez FR, Jimenez AE, Tobon GA, Mote JU, Farias ON. Procalcitonin (PCT), C reactive protein (CRP) and its correlation with severity in early sepsis. Clinical Reviews and Opinions. 2011 Apr 30;3(3):26-31.
- Riedel S, Melendez JH, An AT, Rosenbaum JE, Zenilman JM. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol. 2011 Feb 1;135(2):182-9. doi: 10.1309/AJCP1MFYINQLECV2
- Yunus I, Fasih A, Wang Y. The use of procalcitonin in the determination of severity of sepsis, patient outcomes and infection characteristics. PloS one. 2018 Nov 14;13(11):e0206527. org/10.1371/journal.pone.0206527
- Nargis W, Ibrahim MD, Ahamed BU. Procalcitonin versus C-reactive protein: Usefulness as biomarker of sepsis in ICU patient. Int J Crit Ill Inj Sci. 2014 Jul;4(3):195. doi: 10.4103/2229-5151.141356.
- Charles PE, Dalle F, Aho S, Quenot JP, Doise JM, Aube H, et al. Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients Intensive Care Med. 2006 Oct 1;32(10):1577-83. doi: 1007/s00134-006-0306-3
- Yan ST, Sun LC, Jia HB, Gao W, Yang JP, Zhang GQ. Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria. Am J Emerg Med. 2017 Apr 1;35(4):579-83. doi: 10.1016/j.ajem.2016.12.017.
- Sudhir U, Venkatachalaiah RK, Kumar TA, Rao MY, Kempegowda P. Significance of serum procalcitonin in sepsis. Indian journal of critical care medicine: peer-reviewed, official publication of Indian J Crit Care Med. 2011 Jan;15(1):1. doi: 4103/0972-5229.78214
- Lipińska-Gediga M, Mierzchała-Pasierb M, Durek G. Procalcitonin kinetics–prognostic and diagnostic significance in septic patients. Arch Med Sci: AMS. 2016 Feb 1;12(1):112. doi: 10.5114/aoms.2016.57587
- Azevedo JR, Torres OJ, Czeczko NG, Tuon FF, Nassif PA, Souza GD. Procalcitonin as a prognostic biomarker of severe sepsis and septic shock. Rev Col Bras Cir. 2012Dec;39(6):456-61. doi: 1590/s0100-69912012000600003
- Shokouhi B, Bookani KR, Ghasemi H, Khalouei M, Rezaei NJ, Samani SM. Diagnostic and prognostic performances of serum procalcitonin in patients with bloodstream infections: A parallel, case-control study comprising adults and elderly. Rev Assoc Med Bras. 2017 Jun;63(6):521-6. doi: 1590/1806-9282.63.06.521
- Farrokhpour M, Kiani A, Mortaz E, Taghavi K, Farahbod AM, Fakharian A, et al. Procalcitonin and Proinflammatory Cytokines in Early Diagnosis of Bacterial Infections after Bronchoscopy. Open access Maced J Med Sci. 2019 Mar 30;7(6):913. doi: 3889/oamjms.2019.208
- Mahmoodpoor A, Farzan N, Shadvar K, Entezari-Maleki T, Hamishehkar H. Procalcitonin May Not Discriminate Between Sepsis and Non- Infective Systemic Inflammatory Response Syndrome (SIRS) in Heterogonous Critically Ill Patients. Archives of Clinical Infectious Diseases. 2018;13(1). doi: 10.5812/archcid.55618.
- Sinha M, Desai S, Mantri S, Kulkarni A. Procalcitonin as an adjunctive biomarker in sepsis. Indian journal of anaesthesia. 2011 May;55(3):266. doi:4103/0019-5049.826.
Corresponding Author
Dr Sarita Netra
Department of Microbiology, Sawai Man Singh Medical College and Attached Hospitals, Jaipur,
Rajasthan, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i3.110
