Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Utility of Serum Procalcitonin for Diagnosis of Sepsis and Evaluation of Severity

혈청 프로칼시토닌(serum procalcitonin) 측정을 통한 패혈증 진단 및 중등도 평가의 유용성

  • Park, Tae-Jin (Department of Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Youn-Suck (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 박태진 (울산대학교 의과대학 서울아산병원 중환자의학교실) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과학교실)
  • Received : 2010.08.25
  • Accepted : 2010.11.09
  • Published : 2011.01.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Early recognition and treatment of sepsis would improve patients' outcome. But it is difficult to distinguish between sepsis and non-infectious conditions in the acute phase of clinical deterioration. We studied serum level of procalcitonin (PCT) as a method to diagnose and to evaluate sepsis. Methods: Between 1 March 2009 and 30 September 2009, 178 patients had their serum PCT tested during their clinical deterioration in the medical intensive care unit. These laboratories were evaluated, on a retrospective basis. We classified their clinical status as non-infection, local infection, sepsis, severe sepsis, and septic shock. Then, we compared their clinical status with level of PCT. Results: The number of clinical status is as follows: 18 non-infection, 33 local infection, 39 sepsis, 26 severe sepsis, and 62 septic shock patients. PCT level of non-septic group (non-infection and local infection) and septic group (sepsis, severe sepsis, septic shock) was $0.36{\pm}0.57$ ng/mL and $18.09{\pm}36.53$ ng/mL (p<0.001), respectively. Area under the curve for diagnosis of sepsis using cut-off value of PCT >0.5 ng/mL was 0.841 (p<0.001). Level of PCT as clinical status was statistically different between severe sepsis and septic shock ($^*severe$ sepsis; $4.53{\pm}6.15$ ng/mL, $^*septic$ shock $34.26{\pm}47.10$ ng/mL, $^*p$ <0.001). Conclusion: Level of PCT at clinical deterioration showed diagnostic power for septic condition. The level of PCT was statistically different between severe sepsis and septic shock.

Keywords

References

  1. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 1995;273:117-23. https://doi.org/10.1001/jama.1995.03520260039030
  2. Hong SK, Hong SB, Lim CM, Koh Y. The characteristics and prognostic factors of severe sepsis in patients who were admitted to a medical intensive care unit of a tertiary hospital. Korean J Crit Care Med 2009;24:28-32. https://doi.org/10.4266/kjccm.2009.24.1.28
  3. Vincent JL, Bihari D. Sepsis, severe sepsis or sepsis syndrome: need for clarification. Intensive Care Med 1992; 18:255-7. https://doi.org/10.1007/BF01706468
  4. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341: 515-8. https://doi.org/10.1016/0140-6736(93)90277-N
  5. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864-74. https://doi.org/10.1097/00003246-199206000-00025
  6. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29. https://doi.org/10.1097/00003246-198510000-00009
  7. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. https://doi.org/10.1007/BF01709751
  8. Becker KL, Nylen ES, White JC, Muller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89:1512-25. https://doi.org/10.1210/jc.2002-021444
  9. Meisner M, Muller V, Khakpour Z, Toegel E, Redl H. Induction of procalcitonin and proinflammatory cytokines in an anhepatic baboon endotoxin shock model. Shock 2003;19:187-90. https://doi.org/10.1097/00024382-200302000-00017
  10. Christ-Crain M, Muller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 2007; 30:556-73. https://doi.org/10.1183/09031936.00166106
  11. Christ-Crain M, Muller B. Procalcitonin in bacterial infections-- hype, hope, more or less? Swiss Med Wkly 2005;135:451-60.
  12. Herzum I, Renz H. Inflammatory markers in SIRS, sepsis and septic shock. Curr Med Chem 2008;15:581-7. https://doi.org/10.2174/092986708783769704
  13. Rau BM, Kemppainen EA, Gumbs AA, Buchler MW, Wegscheider K, Bassi C, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg 2007;245:745-54. https://doi.org/10.1097/01.sla.0000252443.22360.46
  14. Whang KT, Steinwald PM, White JC, Nylen ES, Snider RH, Simon GL, et al. Serum calcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab 1998;83:3296-301. https://doi.org/10.1210/jc.83.9.3296
  15. Nakamura A, Wada H, Ikejiri M, Hatada T, Sakurai H, Matsushima Y, et al. Efficacy of procalcitonin in the early diagnosis of bacterial infections in a critical care unit. Shock 2009;31:586-91.
  16. Sandri MT, Passerini R, Leon ME, Peccatori FA, Zorzino L, Salvatici M, et al. Procalcitonin as a useful marker of infection in hemato-oncological patients with fever. Anticancer Res 2008;28:3061-5.
  17. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet 2004;363:600-7. https://doi.org/10.1016/S0140-6736(04)15591-8
  18. Stocker M, Fontana M, El Helou S, Wegscheider K, Berger TM. Use of procalcitonin-guided decision-making to shorten antibiotic therapy in suspected neonatal early-onset sepsis: prospective randomized intervention trial. Neonatology 2010;97:165-74. https://doi.org/10.1159/000241296
  19. Meng FS, Su L, Tang YQ, Wen Q, Liu YS, Liu ZF. Serum procalcitonin at the time of admission to the ICU as a predictor of short-term mortality. Clin Biochem 2009;42:1025-31. https://doi.org/10.1016/j.clinbiochem.2009.03.012

Cited by

  1. Procalcitonin as a Prognosis Marker for the Severe Sepsis and Septic Shock Patients in Emergency Department vol.26, pp.4, 2011, https://doi.org/10.4266/kjccm.2011.26.4.250