engleski

Clinical evaluation of procalcitonin in septic patients

Background: The aim of the study was to assess the clinical value of procalcitonin (PCT) in the diagnosis and severity of sepsis in intensive care unit (ICU) patients. Methods: A total of 133 surgical ICU patients were classified into five diagnostic classes according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria: without infection (52), systemic inflammatory response syndrome (SIRS, 20), sepsis (36), severe sepsis (9) and septic shock (16). The concentration of PCT was determined by an immunofluorescence assay (TRACE – Time Resolved Amplificated Cryptate Emission), BRAHMS KRYPTOR, Germany. Results: The median PCT concentrations in noninfected patients (0.05 ng/mL, range: <0.02-1.4) and SIRS patients (0.18 ng/mL, range: 0.03-5.0) were significantly lower (p<0.001 and p=0.010) than those in septic patients: sepsis (1.98 ng/mL, range: 0.33-126) ; severe sepsis (7.5 ng/mL, range: 3.0-157) ; septic shock (7.42, range: 0.4-320). PCT levels showed a strong correlation with the severity of sepsis. Receiver operating characteristic (ROC) analysis showed an optimal cut-off point of 0.386 ng/mL with sensitivity of 81.8%, specificity of 84.5%, positive predictive value of 83.3%, negative predictive value of 86.3% and diagnostic odds ratio of 24.5, in differentiating patients without infection and with SIRS from those with sepsis. Conclusions: The results showed the PCT to be a reliable marker of sepsis in ICU patients. PCT concentrations efficiently distinguished patients with SIRS and sepsis and showed a strong correlation with the severity of infection, with increasing concentrations in patients with the most severe stages of sepsis: severe sepsis and septic shock.

procalcitonin; sepsis; systemic inflammatory response syndrome; septic shock

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