Title: Biomarkers in Sepsis: A study of Procalcitonin as a diagnostic and prognostication tool in Sepsis in a tertiary care hospital
Authors: Jyotsnaa M, Nanjil Kumaran A, Vijayakumar N, Umarani R
DOI: https://dx.doi.org/10.18535/jmscr/v8i11.33
Abstract
Background: The incidence and mortality from sepsis has been on a rising trend worldwide. Early diagnosis and intervention are key to reducing morbidity and mortality from sepsis. Biomarkers are gaining prominence in this regard. Of these, procalcitonin (PCT) which is elaborated by the tissues in response to the inflammatory response of sepsis, has high sensitivity and specificity to diagnose sepsis.
Aims and Objectives: The study was done with the aim to assess the prevalence of elevated serum procalcitonin levels in patients with sepsis, and to evaluate for correlation of procalcitonin levels with severity of sepsis, clinical course, prognosis (assessed by prognostication scores like qSOFA, SOFA, APACHE II scores) and treatment outcome of sepsis.
Methods: 40 patients admitted with sepsis in the medical ICU of Rajah Muthiah Medical College Hospital during the period from September 2018 to August 2020 were studied. Demographic characteristics, history and physical examination details of the patients were entered in a case proforma. qSOFA score was calculated from GCS, respiratory rate and systolic BP. Shock index was calculated from heart rate and systolic BP. A venous sample for procalcitonin estimation was obtained in first 12 hours. Investigations from workup of the patient and clinical status were used to calculate SOFA and APACHE II score. The clinical course and treatment of the patients were followed up. Statistical analysis of the above data was performed.
Results: Among the 40 sepsis patients studied, 20% had sepsis (n=8), 40% each severe sepsis and septic shock (n=16 in each category). The overall mortality was 25% (n=10), with highest mortality in patients with septic shock. The mean PCT of study subjects was 5.64 ± 15.05 ng/ml. PCT may be used to predict mortality as survivors had mean PCT of 2.75 ± 4.10 ng/ml compared to 14.29 ± 28.57 ng/ml in non-survivors (p < 0.05). Greater PCT values were associated with need for ventilatory support (mean 8.86 ± 21.78 ng/ml, p <0.05). PCT levels were greater with greater severity of sepsis: the mean PCT was 1.77 ± 2.66 ng/ml in sepsis, compared to 3.05 ± 4.29 ng/ml in severe sepsis, and 10.16 ± 22.90 ng/ml in septic shock. qSOFA score and CRP were good independent predictors of mortality (p < 0.05 and p < 0.0001 respectively) and showed positive correlation with PCT.
Conclusion: Serum PCT may be used to diagnose sepsis at an early stage. In addition, it is useful to categorize severity of sepsis, predict mortality and need for ventilatory support in patients with sepsis.
Keywords: Sepsis, procalcitonin, biomarkers, septic shock, CRP, SOFA, APACHE II score, shock index, prognostic indicator.
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