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Category: Volume 08 Issue 03 March 2020
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Title: Serum Procalcitonin: A Suggestive Predictor for Sepsis among Critically Ill Patients at S.M.S. Hospital, Jaipur

Authors: Dr Sarita Netra, Dr Rameshwari Bithu

 DOI: https://dx.doi.org/10.18535/jmscr/v8i3.110

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.

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Corresponding Author

Dr Sarita Netra

Department of Microbiology, Sawai Man Singh Medical College and Attached Hospitals, Jaipur,

Rajasthan, India