AN OBSERVATIONAL STUDY TO EVALUATE THE USEFULNESS OF PROCALCITONIN AS A BIOMARKER OF SEPSIS IN THE EARLY STRATIFICATION OF ADULT PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT WITH SUSPECTED INFECTION.
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Serum Procalcitonin(PCT) has become useful as a biomarker to assist in the diagnosis of sepsis, as well as related infectious or inammatory conditions. It is a soluble protein liberated into the circulation of patients in response to severe systemic inammation, in particular by bacterial infection. The aim of this study was to evaluate the usefulness of Procalcitonin as a biomarker of sepsis in the early stratication of adult patients admitted to the intensive care unit with suspected infection.Patients are randomly divided into two groups , Group-1: comprising those patients with a bacterial infection (SIRS with Sepsis) and Group -2: comprising patients without a bacterial infection (SIRS without Sepsis). we found that elevated PCT concentrations (> 0.5ng/ml) were detected in a signicantly higher proportion of patients with SIRS with sepsis compared to those with SIRS without sepsis so we concluded that PCT is an excellent marker providing the additive effect to improve the predictive power for diagnosing sepsis, for assessing severity of sepsis, and also for predicting the outcome/prognosis.Keywords:
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Objective: The primary objective of this study was to determine if the addition of procalcitonin to the existing systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA) scoring systems could improve the predictability of in-hospital sepsis-related mortality. Secondarily, we sought to determine if the addition of procalcitonin could predict the likelihood of ICU admission and discharge home. Design: This is a retrospective, single-center, observational study that looked at data from January 1, 2017 to January 1, 2019. Patients were stratified into four groups: SIRS-positive + procalcitonin >2 ng/mL (pSIRS+), SIRS-positive + procalcitonin ≤2 ng/mL (pSIRS-), qSOFA-positive + procalcitonin >2 ng/mL (pqSOFA+), and qSOFA-positive + procalcitonin ≤2 ng/mL (pqSOFA-). Setting: The study was conducted at a community hospital in Las Vegas, Nevada. Patients: Patients were included in the study if they were >18 years of age and had hospital admission diagnosis of sepsis with at least one value of procalcitonin level. Interventions: After patients which met the inclusion criteria, patients were divided into subgroups of SIRS, SIRS + procalcitonin > 2 ng/mL, qSOFA, qSOFA + procalcitonin >2 ng/mL. Primary outcomes were in-hospital mortality and secondary outcomes were ICU admission, length of stay, and discharge to home. Results: 933 patients were included in the study with an overall mortality rate of 21.22%, an overall ICU admission rate of 56.15%, and an overall discharge home rate of 29.58%. In those identified with a sepsis-related diagnosis code, pSIRS+ predicted an in-hospital mortality rate of 31.89% compared to pSIRS- 16.15% (P < 0.0001). In regards to qSOFA, the addition of procalcitonin added no statistically significant difference in predicting in-hospital mortality. pSIRS+ patients were found to have an ICU admission rate of 76.16% and a discharge home rate of 19.20% compared to pSIRS- who had 47.40% and 34.90%, respectively (P < 0.0001). Like in our primary outcome, our data for qSOFA was not statistically significant. Conclusions: Procalcitonin added utility to the SIRS scoring system in predicting sepsis-related in-hospital mortality, ICU admission, and discharge home. Procalcitonin did not add statistically significant benefit to the qSOFA scoring system in predicting sepsis-related in-hospital mortality, ICU admission, and discharge home.
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Objective To explore correlation between the systemic inflammatory response syndrome(systemicinflammatory syndrome, SIRS) and the serum procalcitonin(procalcitonin, PCT). Methods 195 cases of children with systemic inflammatory reaction in our hospital from June 2012 to June 2014 were divided into noninfection SIRS group(30 cases, denoted as A group), bacterial infection SIRS group(120 cases of bacterial infection, denoted as B group), non bacterial infection SIRS group(45 cases, denoted as C group)according to the primary disease type, and all children were got the detection of serum PCT with electrochemical luminescence immunoassay, then the serum PCT content were observed in the 3 groups. we would evaluated the value of serum PCT in the diagnosis of SIRS infection. Results In A group, B group, C group, the content of serum PCT of patients were(0.5 ± 0.2)ng/m L,(1.3 ± 0.6)ng/m L and(0.3 ± 0.1)ng/m L. PCT in serum of B group was significantly higher than that of A group, C group, the difference was statistically significant(P 0.05). Conclusion Serum PCT can be used as one of index in the diagnosis of clinical SIRS assisted standard, and the inflammatory response leads to a specific reaction of systemic bacterial infection.
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Sepsis is featured with acute onset, rapid progress and high mortality. Because its clinical manifestations is very similar to noninfectious systemic inflammatory response syndrome, it is difficult to diffferentiate the two diseases, which results in delayed use or abuse of anti-infective drugs. Procalcitonin is widely recognized as a sepsis biomarker, but it has its limits. Procalcitonin must be interpreted cautiously, in conjunction with the clinical picture. Dynamic monitoring of procalcitonin can give clinicians more help.(Chin J Lab Med, 2015, 38: 364-366)
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Sepsis; Procalcitonin; Systemic inflammatory response syndrome
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Procalcitonin (PCT) is a marker of the inflammatory response to infection and not released in viral disease. The aim of the present study was to determine the level of PCT in sepsis and non-infectious systemic inflammatory response syndrome (SIRS) We determined the level of serum PCT in 50 sepsis and 50 non-infectious SIRS cases, using semiquantitative PCT-Q kit. The frequency of PCT positivity was significantly higher in sepsis than non-infectious SIRS (P < 0.001). Using cut off value of 2 ng/ml for PCT, the sensitivity, specificity, positive predictive value and negative predictive value for serum PCT in distinguishing sepsis from non-infectious SIRS were 88.0, 90.0, 89.8 and 88.2%, respectively. The serum PCT is a reliable marker for distinguishing sepsis from non-infectious SIRS in association with clinical judgment and other paraclinical findings.
Key words: Sepsis, SIRS, procalcitonin.
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Objective Cardiac surgery with cardiopulmonary bypass(CPB) can evoke systemic inflammatory response syndrome(SIRS).Procalcitonin(PCT) is widely used for the differential diagnosis of infectious or non-infectious systemic inflammatory response.This article aimed to investigate the value of PCT in predicting the degree of SIRS after CPB.Methods We included in this study 80 patients undergoing valve replacement,who were divided the into two groups according to the severity of SIRS.We determined the concentrations of PCT,IL-6 and CRP in the plasma before operation(T0),8 hours after surgery(T8 h) and 1 to 7 days after surgery(T1-T7),and analyzed the pattern and correlation of their changes.Results After surgery,the PCT level exhibited a significant elevation from T8 h to T4(P0.05),extremely significant from T8 h to T3(P0.01) in the severe SIRS group as compared with the mild SIRS group,the CRP level was significantly higher from T3 to T7(P0.05) in the former than in the latter,while the IL-6 level showed no statistically significant difference between the two groups(P0.05).Conclusion Compared with CRP and IL-6,PCT expresses earlier and more significantly in the plasma of the patients with severe SIRS,which suggests that it might be a good predicting marker.
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We studied the usefulness of serum procalcitonin (PCT), interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP) levels and C-reactive protein (CRP) levels, in differentiating between systemic inflammatory response syndrome (SIRS) and sepsis in critically ill patients. Methods. In this single centre prospective observational study we included all consecutive patients admitted with SIRS or sepsis to the ICU. Blood samples for measuring CRP, PCT, IL-6 and LBP were taken every day until ICU discharge. Results. A total of 76 patients were included, 32 with sepsis and 44 with SIRS. Patients with sepsis were sicker on admission and had a higher mortality. CRP, PCT, IL-6 and LBP levels were significantly higher in patients with sepsis as compared to SIRS. With PCT levels in the first 24 hours after ICU admission <2 ng/mL, sepsis was virtually excluded (negative predictive value 97%). With PCT >10 ng/mL, sepsis with bacterial infection was very likely (positive predictive value 88%). PCT was best at discriminating between SIRS and sepsis with the highest area under the ROC curve (0.95, 95% CI 0.90-0.99). Discussion. This study showed that PCT is more useful than LBP, CRP and IL-6 in differentiating sepsis from SIRS.
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The terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock and multiorgan failure (MOF) are currently used to characterize the progressive stages of a very complex and therapeutically challenging disorder of the immune and inflammatory systems. Although SIRS is a result of a systemic activation of the innate immune system regardless of cause, sepsis, severe sepsis, and septic shock are accompanied by proven or suspected infection with or without impaired organ function. Despite tremendous research efforts for over 20 years, sepsis remains the leading cause of death in intensive care units (ICUs). SIRS and sepsis occur in approximately 750,000 patients per year in the United States, with a rising incidence of approximately 1.5% per year (1). With a mortality rate of currently 30% to 70%, sepsis and related disorders represent a major burden to the U.S. health care system, with costs estimated to be approximately $16.7 billion per year (2).
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