Diagnostic utility of serum procalcitonin as a biomarker of sepsis and infection in post-operative patients at tertiary care centre
DOI:
https://doi.org/10.18203/2349-2902.isj20202848Keywords:
Procalcitonin, Post-operative sepsis, E. coliAbstract
Background: Procalcitonin (PCT), the precursor peptide of calcitonin, a hormone involved in calcium homeostasis, is present in normal subjects in extremely low serum levels (0.1 to 0.5 ng/ml). In response to bacterial infectious stimulation serum procalcitonin rises substantially and its role in inflammatory response includes chemotactic function modulation of inducible nitric oxide synthase and induction of cytokines, among other. The objective of this study to assess serum procalcitonin as a biomarker of sepsis and infection in post op patients.
Methods: The present descriptive observational study was conducted at Department of Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry from September 2018 to June 2020. Total 48 patients who had undergone surgery and presented with post-surgical sepsis were included. Data entered in MS excel sheet and analysed by using SPSS 24.0 version IBM USA.
Results: Out of 48 cases, majority of cases i.e. 18 (37.5%) were from 36-50 years age group followed by 11 (22.9%) from 51-60 years age group. Prevalence of sepsis was 20.8%, septic shock 25%, severe sepsis 33.3% and SIRS 14.6%. Procalcitonin (PCT) assay shows positive in 47 (97.9%) cases. E. coli were isolated from 5 (45.5%) cases with PCT 2-10 as compared to 6 (16.7%) cases with PCT >10.
Conclusions: PCT shares remarkable promise as a marker of sepsis and can be used as a routine lab parameter. It was also found to be an accurate diagnostic parameter for differentiating various stages of sepsis and predicting the outcome.
References
Angus DC, Zwirble LWT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303-10.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546-54.
Bone RC, Balk RA, Cerra FB. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 2009;136:28.
Bates DW, Cook EF, Goldman L, Lee TH. Predicting bacteraemia in hospitalized patients. A prospectively validated model. Ann Intern Med. 1990;113:495-500.
Bates DW, Sands K, Miller E. Predicting bacteraemia in patients with sepsis syndrome. Academic Medical Center Consortium Sepsis Project Working Group. J Infect Dis. 1997;176:1538-51.
Sexton PM, Christopoulos G, Christopoulos A, Nylen ES, Snider RH, Becker KL. Procalcitonin has bioactivity at calcitonin receptor family complexes: potential mediator implications in sepsis. Crit Care Med. 2008;36(5):1637-40.
Hoffmann G, Totzke G, Seibel M, Smolny M, Wiedermann FJ, Schobersberger W. In vitro modulation of inducible nitric oxide synthase gene expression and nitric oxide synthesis by procalcitonin. Crit Care Med. 2001;29(1):112-6.
Macedo JLS, Rosa SC, Macedo KCS, Castro C. Fatores de risco da sepse em pacientes queimados. Rev Col Bras Cir. 2005;32(4):173-7.
Macri MM, Matias JEF, Souza CJF, Nicoluzzi JEL, Caron PE, Repka JCD. Influencia do pneumoperitonio nas funcoes hepatica e renal e na liberacao de citocinas pro-inflamatorias em modelo experimental de endotoxemia induzida por lipopolissacarideo de Escherichia coli. ABCD arq bras cir dig. 2009;22(4):206-11.
Lima JBA. Skare TL, Malafaia O, Filho RJM, Michaelis T, Ribas FM, et al. Sindrome de disfuncao de multiplos orgaos induzida por sepse: estudo experimental em ratos. ABCD arq bras cir dig. 2011;24(2):95-102.
Tang BM, Eslick GD, Craig JC, Lean MAS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7(3):210-7.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2008;34(1):17-60.
Boo NY, Azlina AN, Rohana J. Usefulness of a semi-quantitative procalcitonin test kit for early diagnosis of neonatal sepsis. Singapore Med J. 2008;49(3):204.
Sinha M, Desai S, Mantri S, Kulkarni A. Procalcitonin as an adjunctive biomarker in sepsis. Indian J Anaesth. 2011;55:266-70.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546-54.
Todi S, Chatterjee S, Bhattacharyya M. Epidemiology of severe sepsis in India. Crit Care Med. 2007;11:65.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. American College of Chest Physicians (ACCP)/Society of Critical Care Medicine (SCCM) AACP/SCCM consensus conference: definitions of sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864-74.
Velayuthannair MR. Serum procalcitonin as an indicator of sepsis. University J Medicine Med Specialities. 2017;3(2):51.
Vaziri M, Ehsanipour F, Pazouki A, Tamannaie Z, Taghavi R, Pishgahroudsari M, et al. Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis. Med J Islamic Republic Iran. 2014;28:50.
Afsar I, Sener AG. Is Procalcitonin a Diagnostic and/or Prognostic Marker in Sepsis. Infectious Diseases Clin Practice. 2015;23:3-6.
Kibe S, Adams K, Barlow G. Diagnostic and prognostic biomarkers of sepsis in critical care. J Antimicrob Chemother. 2011;66(2):33-40.