Diagnostic Utility of Procalcitonin and Neutrophil-Lymphocyte Ratio in Bacterial Septicaemia - A Retrospective Case Control Study from a Tertiary Care Institute

Abstract

BACKGROUND Sepsis is a frequently encountered critical care problem wherein great emphasis is laid on early and accurate diagnosis of the infective organism. Blood culture though precise, is time consuming. Empiric antibiotic therapy leads to development of antibiotic resistance amongst organisms. Thus, there is a need for a biomarker that is cost effective, simple and rapid to perform. Procalcitonin elevates in response to chemical mediators produced due to bacteraemia within 2 - 4 hours and serves as an early marker. Neutrophil-Lymphocyte Ratio is available universally and is highly cost-effective. We wanted to assess the utility of Procalcitonin (PCT) and Neutrophil-Lymphocyte Ratio (NLR) in detecting the bloodstream infections and determine their usefulness in establishing the nature of infective organisms. METHODS A retrospective case control study was undertaken from January 2018 to December 2018 in a tertiary care teaching hospital in Madurai, Tamil Nadu. Patients tested for serum PCT, complete blood count and blood culture simultaneously prior to antibiotic therapy were included in the study (n = 288). The study cohort was classified into two groups. Group I, controls (n = 155) and group II, cases (n = 133). Out of 133 patients, 73 % (98) were infected by Gramnegative bacteria and 27 % (35) by Gram-positive bacteria. Data was analysed using SPSS V.16 software (SPSS Inc., Chicago, IL, USA). Students unpaired t test and Mann-Whitney U test were used for intergroup comparisons of continuous variables. p < 0.05 was considered to be statistically significant. Cut off for detecting bacteriemia and gram negative bacteriemia was created using Receiver Operating Characteristic (ROC) curve. RESULTS The area under ROC of PCT to detect gram negative bacteraemia was 0.752 (95 % CI = 0.692 – 0.812). CONCLUSIONS Escherichia coli was the most frequent cause of sepsis. Higher levels of PCT and NLR were associated with gram negative organisms. PCT levels can help in determining the cause of infection. NLR and PCT are able to establish the presence of bacteraemia in a short span of time, thus alleviating the over dependence on blood culture reporting. Such earlier decision-making tools help in reducing empirical antibiotic usage and thereby lessen the burden of bacterial resistance to antibiotics. KEYWORDS Procalcitonin, PCT, Neutrophil Lymphocyte Ratio, NLR, Gram Negative Bacteria, Sepsis, Biomarker

The Effectiveness of Adjuvant Attangaogam (Athanam) Yoga Asana-Pranayamam Practices With Regard to Biochemical, Inflammatory, and Hematological Markers Among COVID-19 Patients at a Tertiary Care Hospital in Southern Tamilnadu

“…The blood investigations of study subjects revealed the elevation of various inflammatory markers, as shown in Table 3. These findings are comparable to previous reports documenting COVID-19 infections on admission [10,11]. The data on elevated levels of various inflammatory markers such as CRP >10 mg/dL (83%), LDH >100 IU/L (98%), IL-6 >6 pg/ml (85%), ferritin (males >220 ng/ml, females: >120 ng/ml) (77%), Ddimer >500 ng/ml (30%), and PCT >0.1 ng/ml (74%) at the time of admission is shown in Figure 2.…”

“…Of note, 77% of the patients showed ferritin elevation at the time of admission, evidencing immune dysregulation and indicating life-threatening hyperinflammation because of cell damage [10], which decreased to 22% post-one month and to 3% post-three months. The mean hemoglobin was 12.8 ± 0.35 g/dl, and TLC was 8303 ± 3986, which is comparable to other published studies [16][17][18].…”

“…Serum IL-6 concentration was estimated by using ELISA with a commercially available human IL-6 ELISA kit (Biotech Investissement, Besançon, France) as per the manufacturer's instructions. Serum ferritin, PCT, and D-dimer were measured by fluorescent immunoassay by sandwich immuno-detection method using i-Chroma analyzer [10].…”

“…LDH value ranged from 88-1716 IU/L with a mean of 802 ± 89 IU/L on admission. LDH is an enzyme that helps in the interconversion of lactate to pyruvate in the cells, an immune surveillance prognostic biomarker [10,13]. The Attangaogam benefitted patients who practiced it and only 8% of them showed LDH elevation after practice, whereas in another study, 27% of patients had continued LDH elevation due to persistent inflammation [17].…”