PROCALCITONIN FOR IMPROVED ASSESSMENT AND AN ANSWER TO SEPSIS DILEMMA IN CRITICALLY ILL - A MYTH, A HYPE, OR A REALITY ?
Background and objectives: “Sepsis is a major cause for mortality in critically ill patients all over the world. The number of patients presenting with sepsis, septic shock is gradually increasing in daily clinical practice. Mortality in sepsis is mainly due to a delay in diagnosis and initiation of specific therapy(antibiotics).This is in turn mainly attributed to the difficulty in differentiating infectious trigger(sepsis) from non infectious triggers as both present with similar clinical features. Lack of specific marker adds to this dilemma of differentiating infectious and non infectious factors in critically ill patients.
Recently there are some reports from European countries on role of Procalcitonin (PCT) in critically ill patients. Draw backs of these studies are galore mainly due to the difficulties in interpretation of results, as varying definitions for sepsis are used. But also there is paucity of data on Procalcitonin from Indian sub continent. Hence in the present single centre prospective observational study conducted at tertiary care medical college hospital , A total of 50 adult patients with sepsis fulfilling ACCP/SCCM guidelines were included, out of which 23 were in SIRS/Sepsis, 14 in severe sepsis and 13 in septic shock. Procalcitonin was evaluated in the first 24 hours after admission and before initiation of any antibiotic therapy. The role of procalcitonin was analyzed in relation to confirming sepsis, assessing the severity of sepsis and assessing the prognosis(possible out come) of sepsis. Combined role of procalcitonin with other indicators especially ESR, SOFA Score, Blood/relevant material culture was explored.
Results: Our study confirmed the importance of procalcitonin in critically ill patients particularly in improving the predictive power while solving the sepsis dilemma.
Conclusions: From our study, we conclude that Procalcitonin is not a myth nor a hype but it is a hard reality and is an answer to sepsis dilemma. It is therefore preferable to add Procalcitonin into the standard workup of critically ill patients with suspected sepsis in every day clinical practice.
Keywords:Procalcitonin - PCT - SOFA Score - Sepsis - Septic shock - ACCP/SCCM guidelines - Sepsis dilemma
24 April 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Snider RH Jr, Nylen ES, Becker KL. Procalcitonin & its component pept ides in systemic inf lammat ion, immunochemical characterization. Investing Med 1997; 45: 552-560.
- 2 Chaudhury A, Rao TV. Bacteraemia in a tertiary care urban hospital in south India. Indian J Pathol Microbiol 1999; 42: 317-20.
- 3 Brun-Buisson C Doyon F, Carlet J, et al. -incidence, risk factor, and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. JAMA 1995; 274: 968-974.
- 4 Calandra T, Cohen J et al 'The international sepsis forum consensus conference on definition of infection in the intensive care unit"; Critical care medicine 2005; 3: 1538-1548
- 5 Stephen Harbarth S, Holeckova K, Froidevaux C et al: Diagnostic value of procalcitonin, 1L-6 & IL-8 in critically ill patients with suspected sepsis, Am J Respir, Crit Care Med.2001; 164(3): 396-402.
- 6 Vincent JL, Moreno R, Takala J et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996; 22: 707-710.
- 7 Todi S, Chatterjee S and Bhattacharyya, Epidemiology of severe sepsis in India from 27th International Symposium on Intensive Care and Emergency Medicine, Critical Care 2007, 1 l (Suppl 2): P65.
- 8 Mylen ES, Snider RH Jr. Thompson KA, Rohatgi P, Becker KL. Pneumonitis associated hyperprocalcitonnemia. Am J Med Sci 1996; 312: 12-18
- 9 Brunkhorst FM Wegscheider K, Forycki ZF , Brunkhorst R. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock.. Intensive care med 2000, 26 (suppl 2): 148- 152.
- 10 Meisner M, et al. "Comparison of procalcitonin & CRP plasma Concentrations at different SOFA scores during the course of sepsis and MODS". Crit Care Med. 1999; 3: 45-50.
- 11 Chan YL et al. Procalcitonin as a marker of bacterial infection in Emergency department Crit Care Med. 2004; 8(1): R12-R20
- 12 Kasper. D.L. etal.. Harrisons principles of internal medicine 17 edition New York: MeGraw Hill. 2; 1689-1701
- 13 Meisner M: Procalcitonin - A new Innovate infection parameter. Biochemical & clinical aspects. Thieme Stuttgart, New York 2000, ISBN: 3-13-105503-0.
- 14 Becker KL, et al. Clinical review of Procalcitonin and the calcitonin gene family of peptides in inflammation, infection & sepsis: J Clin Endocrinol Metab. 2004; 89: 1512-1525.
- 15 Muller B, Becker KL. Procalcitonin how a hormone became a marker and mediator of sepsis. swiss med weekly 2001; 131: 596-602
- 16 Whang KT et al, Serum procalcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab. 1998; 83: 3296-3301.
- 17 Meisner. Pathobiochemistry and clinical use of procalcitonin. Clin Chem 2002; 323: 17-29.
- 18 Meisner M, et al. Clinical experiences with a new, semiquantitative solid phase immunoassay for rapid measurement of procalcitonin. Clin. Chem. Lab. Med.2000; 38 (lG): 989-995.
- 19 Simon L, Gauvtn f Anre K, Saint-Louis P, Lacroix J. Serum Procalcitonin & CRP levels as markers of bacterial infection. A systemic review & meta-analysis. Clin Infect Dis 2004; 39: 206-217.
- 20 Cincent J-L. Procalcitonin : The marker of sepsis Crit Care Med. 2000; 28: 1226-1227.
- 21 Muiler B, Becker KL, Schachfnger H, et al. Calcitonin precursor are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000; 28: 977-983.
- 22 Brunkhorst FM, Eberhard OK, Brunkhorst R: Discrimination of infectious and noninfectious causes of early acute respiratory distress Syndrome by procalcitonin. Crit Care Med 1999; 27: 2172-2176.
- 23 Gian Paolo Castelli, et al. "Procalcitonin and CRP during SIRS, sepsis and organ dysfunction". Crit Care Med, 8: 234-R242.
- 24 American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Critical Care Med 1992; 20: 864-874.
- 25 Moreno R, Vincent JL, Matos R, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective multicentre study. Intensive Care Med 1999; 25: 686-696.
- 26 Martin GS, ManninoDM, Eaton.S and Moss.M 2003; "The Epidemiology of sepsis in United States from 1979 through 2000; N eng j .Med 348; 1524 -5446.
- 27 Sands KL, Bates DW, Lanken PW, et al. Epidemiology of sepsis syndrome in 8 academic medical centers. JAMA 1997; 278: 234-240.