Role of Procalcitonin Levels in Patients with Sepsis in Medical Intensive Care Unit
DOI:
https://doi.org/10.55489/njmr.12032022906Keywords:
Sepsis, ICU, APACHE II, serum procalcitonin, PCT, mortality rateAbstract
Introduction: Sepsis has a death rate of ∼25% globally and its clinical treatment presents an important clinical challenge. The Acute Physiology and Chronic Health Evaluation II (APACHE II) is the standard method for assessing sepsis. Serum PCT level can be increase in case of sepsis. With this background, the present research is aimed to study the survival among the sepsis cases and correlate them with serum procalcitonin levels, APACHE II Score and other risk factors.
Methodology: The study was conducted among 75 cases diagnosed having sepsis admitted in medical ICU. APACHE II score, serum procalcitonin (PCT) and other investigation were carried out along with clinical history and examination. Data were analysed using epi-info software.
Results: The cases fatality rate of sepsis cases in medical intensive care unit in our hospital was 37.3%. The mortality rate was significantly higher patients with comorbidities, especially cases with respiratory or CNS involvement. The serum PCT levels were significantly higher in the group of non survivors as compared to group of survivors. Higher APACHE II score associated with higher mortality. Serum PCT levels go on increasing along the spectrum of sepsis. A PCT level was significantly hire in culture positive cases compare to sterile cases.
Conclusion: From this study we conclude that serum PCT level is useful investigation in sepsis cases to predict mortality.
References
Linde-Zwirble, WT, Angus, DC. Severe sepsis epidemiology: sampling, selection, and society. Crit Care 2004; 8: 222-226. Doi: https://doi.org/10.1186/cc2917 PMid:15312201 PMCid:PMC522859
Vincent JL, and Moreno R. Clinical review. scoring system in the critical ill, Critical Care. 2010;14:207. Doi: https://doi.org/10.1186/cc8204 PMid:20392287 PMCid:PMC2887099
Rapsang AG and Shyam DC. Scoring systems in intensive care unit A compendium. Ind J Critic Care Med. 2014;18(4):220-8. Doi: https://doi.org/10.4103/0972-5229.130573 PMid:24872651 PMCid:PMC4033855
Desai S, and Lakhani JD. Utility of SOFA and APACHE II Score in Sepsis in Rural Set up MICU. Journal of the Association of physicians of India. 2013;61:608-11.
Knaus, WA, Draper, EA, Wagner, DP. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-829. Doi: https://doi.org/10.1097/00003246-198510000-00009 PMid:3928249
Jamal Q, Rahman AS, Muhammad A, Siddiqui MA, Riaz M, Ansari M and Saleemullah. Apache II scoring as an index of severity in Organ phosphorus Poisoning. J Clin Toxicol. 2014;7:354.
Bouch CD, and Thompson JP. Severity Scoring System in the critically ill. Continuing Education in Anaesthesia. Critical Care Pain J. 2008;8(5):181-5. Doi: https://doi.org/10.1093/bjaceaccp/mkn033
Johnsons S and Saranya AVR, Comparison of different scoring systems used in intensive care unit. J Pulm Repair Med. 2015;5:276. Doi: https://doi.org/10.4172/2161-105X.1000276
Schmeider, HG, Lam, QT. Procalcitonin for the clinical laboratory: a review. Pathology 2007; 39: 383-390. Doi: https://doi.org/10.1080/00313020701444564 PMid:17676478
Bloos, F, Marshall, JC, Dellinger, RP. Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study. Crit Care 2011; 15: R88-R88. Doi: https://doi.org/10.1186/cc10087 PMid:21385367 PMCid:PMC3219347
Jain S, Sinha S et al. Procalcitonin as a prognostic marker for sepsis: a prospective observational study. BMC Research Notes. 2014; 7:458. Doi: https://doi.org/10.1186/1756-0500-7-458 PMid:25034373 PMCid:PMC4105100
Rhee C, Jones T et al. Prevalence, underlying causes and preventability of sepsis- associated mortality in US acute care hospital. JAMA 2019; Doi: https://doi.org/10.1001/jamanetworkopen.2018.7571 PMid:30768188 PMCid:PMC6484603
Arturo Artero, Rafael Zaragoza and José Miguel Nogueira (2012). Epidemiology of Severe Sepsis and Septic Shock, Se-vere Sepsis and Septic Shock - Understanding a Serious Killer, Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307- 950-9. Doi: https://doi.org/10.5772/27208
ArteroA , Zaragoza R et al. Prognostic factors of mortality in patients with community acquired blood stream infection with severe sepsis and septic shock. Journal of Critical Care; 2010; 25; 2; 276-281. Doi: https://doi.org/10.1016/j.jcrc.2009.12.004 PMid:20149587
Suarez De La Rica et al. Epidemiology of sepsis in western countries AnnTransl Med 2016;4(17):325. Doi: https://doi.org/10.21037/atm.2016.08.59 PMid:27713883 PMCid:PMC5050194
Clec'h C, Ferriere F et al. Diagnostic and prognostic value of procalcitonin in patients with septic shock.Crit Care Med. 2004; 32; 5; 1166-1169. Doi: https://doi.org/10.1097/01.CCM.0000126263.00551.06 PMid:15190968
Watanbe Y, Oikawa N et al. Ability of procalcitonin to diagnose bacterial infection and bacteria types compared with-blood culture findings. International Journal of General Medicine. 2016:9; 325-331. Doi: https://doi.org/10.2147/IJGM.S115277 PMid:27757046 PMCid:PMC5053384
Karlsson S, Heikkinen M, Pettilä V et al. Predictive value of procalcitonin decreases in patients with severe sepsis: a pro-spective observational study. Crit Care 2010;14:R205. Doi: https://doi.org/10.1186/cc9327 PMid:21078153 PMCid:PMC3219988
Zhao Y, Li C, Jia Y: Evaluation of the Mortality in Emergency Department Sepsis score combined with procalcitonin in septic patients. Am J Emerg Med 31(7):1086Y1091, 2013. Doi: https://doi.org/10.1016/j.ajem.2013.04.008 PMid:23702061
Yang Y, XieJF, Yu KJ, Yao C, Li JG, Guan XD, Yan J, Ma XC, Kang Y, Yang CS, Yao XQ, Shang HC, Qiu HB; for CHESS Study Investigators. Epidemiological Study of Sepsis in China: Protocol of a Cross-sectional Survey. Chin Med J (Engl). 2016 Dec 20;129(24):2967-2973. Doi: https://doi.org/10.4103/0366-6999.195474 PMid:27958229 PMCid:PMC5198532
Anand D, Das S et al. Inter relationship between procalcitonin and organ failure in sepsis..Ind J Clin Biochem. 2014;29:93-96. Doi: https://doi.org/10.1007/s12291-013-0326-z PMid:24478557 PMCid:PMC3903936
Huang WP, Jiang WQ et al. Significance of serum procalcitonin in the evaluation of severity and prognosis of patients with systemic inflammatory response syndrome. Chin Criti Care Med. 2012; 5; 294- 297
Mustafić. S et al. Diagnostic and prognostic value of procalcitonin in patients with sepsis. MedicinskiGlasnik . 2018;15(2): 93-100.
Gupta S, Lemenze A, Donnelly RJ, Connell ND, Kadouri DE. Keeping it together: absence of genetic variation and DNA incorporation by the predatory bacteria Micavibrioaeru-ginosavorus and Bdellovibriobacteriovorus during predation. Res Microbiol. 2018 May - Jun;169(4-5):237-243. Doi: https://doi.org/10.1016/j.resmic.2018.03.002 PMid:29751066
Dolatabadi AA, Memary E, Amini A, Shojaee M, Abdalvand A, Hatamabadi HR. Efficacy of measuring procalcitonin lev-els in determination of prognosis and early diagnosis of bac-terial resistance in sepsis. Niger Med J. 2015 Jan-Feb;56(1):17-22. Doi: https://doi.org/10.4103/0300-1652.149165 PMid:25657488 PMCid:PMC4314854
Ryoo, S.M., Han, K.S., Ahn, S. et al. The usefulness of C-reactive protein and procalcitonin to predict prognosis in septic shock patients: A multicenter prospective registry-based observational study. Sci Rep 9, 6579 (2019) Doi: https://doi.org/10.1038/s41598-019-42972-7 PMid:31036824 PMCid:PMC6488613
Duplessis C et al. Evaluating the discriminating capacity of cell death (apoptotic) biomarkers in sepsis. Journal of intensive care. 2018; 6; 72; 1-11. Doi: https://doi.org/10.1186/s40560-018-0341-5 PMid:30459950 PMCid:PMC6234551
Sharma R et al. Procalcitonin for improved assessment and an answer to sepsis dilemma in critically ill - a myth,a hype, or a reality ? NUJHS. 2014; 4; March 2014
Wacker C, Prkno A, Brunkhorst FM, Schlattmann P et al. Procalcitonin as adiagnostic marker for sepsis: a systematic review and meta-analysis. LancetInfect Dis.2013;13: 426-435. Doi: https://doi.org/10.1016/S1473-3099(12)70323-7 PMid:23375419
Mayr F, Yende S et al. Epidemiology of severe sepsis. Viru-lence.2014;5; 4-11. Doi: https://doi.org/10.4161/viru.27372 PMid:24335434 PMCid:PMC3916382
Kaukonen K et al. Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308-1316. Doi: https://doi.org/10.1001/jama.2014.2637 PMid:24638143
Sua'rez-Santamarı'a M, Santolaria F et al. Prognostic value of inflammatorymarkers (notably cytokines and procalcitonin), nutritional assessment, and organ function in patients with sepsis. Eur Cytokine Netw 21(1):19Y26, 2010. Doi: https://doi.org/10.1684/ecn.2009.0185 PMid:20146986
Khan AA, Singh R, Singh PK. Diagnostic and prognostic significance of procalcitonin in septicemia. Int J Adv Med 2017;4:630-4. Doi: https://doi.org/10.18203/2349-3933.ijam20171463
Rey C, García-Hernández I, Concha A, Martínez-Camblor P, Botrán M, Medina A, Prieto B, López-Herce J. Proadrenome-dullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: a prospective study. Crit Care. 2013 Oct 16;17(5):R240. Doi: https://doi.org/10.1186/cc13064 PMid:24131732 PMCid:PMC3840693
Szederjesi J. Almasy E et al. An evaluation of serum procalci-tonin and c-reactive protein levels as diagnostic and prognos-tic biomarkers of severe sepsis.The Journal of Critical Care Medicine. 2015;1(4):147-153. Doi:https://doi.org/10.1515/jccm-2015-0022 PMid:29967823 PMCid:PMC5953295
Huang S et al. Investigate the relation of procalcitonin and prognosis in severe septic patients in SICU. Intensive Care Medicine Experimental. 2015; 3; A870. Doi: https://doi.org/10.1186/2197-425X-3-S1-A870 PMCid:PMC4798415
López et al. Procalcitonin (PCT), C reactive protein (CRP) and its correlation with severity in early sepsisClin. Rev. Opinions. 2011; 3(3), pp. 26-31.
Wang S et al. The correlation between procalcitonin, C-reactive protein and severity scores in patients with sepsis and their value in assessment of prognosis. Chin Crit Care Med. 2015; 27;97-101
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Copyright (c) 2022 Dattatreya Sarkar, Rajeev Chatterji
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