Untitled

Abstract

IntroductionThe term 'sepsis' is used to define the systemic inflammatory response to an infectious agent (i.e. bacterial, viral, fungal or parasitic). Despite the use of new treatment modalities, improvements in technology and increased experience, mortality rates in sepsis remain high [1,2]. Critical care physicians have at their disposal a variety of data to serve as a guide in discriminating infectious from noninfectious conditions in newly admitted patients. In a number of newly admitted patients the diagnosis of sepsis becomes clear after taking the medical history and completing the physical examination 85 APACHE = Acute Physiology and Chronic Health Evaluation; AUC = area under the receiver operating characteristic curve; CRP = C-reactive protein; ICU = intensive care unit; IL = interleukin; PCT = procalcitonin; SIRS = systemic inflammatory response syndrome; TNF = tumour necrosis factor. AbstractIntroduction The diagnosis of sepsis in critically ill patients is challenging because traditional markers of infection are often misleading. The present study was conducted to determine the procalcitonin level at early diagnosis (and differentiation) in patients with systemic inflammatory response syndrome (SIRS) and sepsis, in comparison with C-reactive protein, IL-2, IL-6, IL-8 and tumour necrosis factor-α. Method Thirty-three intensive care unit patients were diagnosed with SIRS, sepsis or septic shock, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria. Blood samples were taken on the first and second day of hospitalization, and on the day of discharge or on the day of death. For multiple group comparisons one-way analysis of variance was applied, with post hoc comparison. Sensitivity, specificity and predictive values for PCT and each cytokine studied were calculated. Results PCT, IL-2 and IL-8 levels increased in parallel with the severity of the clinical condition of the patient. PCT exhibited a greatest sensitivity (85%) and specificity (91%) in differentiating patients with SIRS from those with sepsis. With respect to positive and negative predictive values, PCT markedly exceeded other variables. Discussion In the present study PCT was found to be a more accurate diagnostic parameter for differentiating SIRS and sepsis, and therefore daily determinations of PCT may be helpful in the follow up of critically ill patients.

Procalcitonin as a Marker for Early Diagnosis of Sepsis

“…Through various studies, procalcitonin was one of the markers which have been suggested for more rapid diagnosis of sepsis (Canan et al, 2003).…”

“…Of these studies, Canan et al (2003) have stated that the procalcitonin sensitivity and specificity for differentiating SIRS from sepsis, is 85 and 91% respectively.…”

“…These criteria have low sensitivity and specificity for detecting disease, in spite of the fact that the existing of non-infectious various disease and conditions, including trauma, pancreatitis, cardiac infarction, cardiac tapenade and cause to make false positive and negative results in diagnosis of SIRS (Canan et al, 2003;Mandell et al, 1995). At the present, diagnosis of sepsis is a controversial.…”

“…One of these markers is Procalcitonin (a prohormones which composed of 116 amino acids) which is very useful in sepsis diagnosis in cases that the blood culture test is negative and its level is associated with sepsis severity (Canan et al, 2003). It seems that specificity of this marker is higher than CRP and WBC count and it tends to rise quickly as bacterial infections (but not viral infections) develop, increase with the severity of infection and decline with improvement (PCCM, 2013).…”

Use of a Combination Biomarker Algorithm To Identify Medical Intensive Care Unit Patients with Suspected Sepsis at Very Low Likelihood of Bacterial Infection

“…Several studies have evaluated the diagnostic utility of various biomarkers, including ferritin, haptoglobin, interleukin 6, C-reactive protein (CRP), and procalcitonin (PCT), for suspected sepsis in the ICU patient population (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). PCT has been the most-well-studied biomarker and has demonstrated the most promising results to date in the diagnosis of bacterial infection in a number of settings (16)(17)(18)(19)(20)(21).…”