Estimation Of Serum Procalcitonin Levels In Patients With Systemic Inflammatory Response Syndrome And Sepsis - A One Year Hospital Based Cross Sectional Study

Abstract

Background and objectives The present study was undertaken to estimate the levels of serum Procalcitonin in patients with Systemic Inflammatory Response Syndrome and Sepsis and correlate the severity of sepsis with the increase in serum PCT values. Methodology This one year cross sectional study was carried out on a total of 50 consecutive patients with SIRS or Sepsis admitted in Medical ICU from January 2012 to December 2012 in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Results Out of 50 patients, males were 31 (62%) and females were 19 (38%). Most number of patients were seen in age group of 18-30 years (36%), followed by those between 51-60 years (24%). SIRS was seen in 23 (46%) of cases, sepsis was observed in 13 (26%) of cases, Severe Sepsis in 7 (14%) cases and septic shock was observed in 7 (14%). Regards to source of sepsis, 11 (22%) had respiratory system involvement, 9 (18%) had Genitourinary involvement, 9 (18%) had gastrointestinal tract related problems, 7 (14%) had CNS related problems, 4 (8%) had skin and soft-tissue infections, while 14 (28%) had other focus of sepsis or SIRS. Procalcitonin (cut-off ≥2ng/ml) was positive in 25 (50%). CRP was positive in 37 (74%) and negative in 13 (26%). 7 (14%) of cases had blood culture positive and Escherichia coli was the commonest organism isolated (6%). Total count was <4000 in 6 (12%) patients and, >11,000 was noted in 27(54%) of patients and in the remaining 17 (34%) WBC count was normal. Procalcitonin (≥2ng/ml) in comparison with CRP, had a sensitivity of 85.2%, specificity was 95.8%, PPV was 95.6%, and NPV was 88%. CRP in comparison with Procalcitonin, sensitivity was 81.5%, specificity was 34.8%, PPV was 59.5%, and NPV was 61.5%. Serum Procalcitonin showed an increase in patients with sepsis (3.42ng/ml) compared to those with SIRS (0.48ng/ml, p<0.01). Also, the elevation of PCT in patients with Septic shock (4.94ng/ml) was significantly more than in patients with Sepsis (2.74ng/ml) Conclusion and interpretation In our study, increase in serum Procalcitonin was elevated more in patients with sepsis and was found to be a better predictor for differentiating SIRS from Sepsis, compared to CRP, WBC count and other routine markers. There is also a relationship between increasing PCT values and the increasing severity of sepsis, with Septic shock patients having much higher increase in PCT values compared to those with Sepsis and SIRS.