Outcome Prediction by Traditional and New Markers of Inflammation in Patients with Sepsis

Abstract

Patients (n=242) admitted to intensive care unit for longer than 48 hours were categorised for sepsis according to American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus Conference criteria. Body temperature, leukocyte count, C-reactive protein (CRP) and procalcitonin (PCT) as well as tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, IL-8, IL-10 and HLA-DR expression on monocytes were determined. Data of one randomly chosen day per patient entered analysis. Immunologic mediators contributing significantly to outcome were determined by logistic regression analysis. Area under the curves (AUC) of receiver operating characteristic curves of clinical markers of inflammation predicting prognosis were compared with AUC of relevant immunologic mediators. TNF-alpha, IL-6 and HLA-DR expression on monocytes were significantly associated with outcome; the AUC's were 0.835, 0.844 and 0.761 respectively. AUC's for clinical markers were 0.878, 0.811, 0.620 and 0.614 for PCT, CRP, leukocyte count and body temperature respectively. PCT had the highest AUC compared to other clinical markers. These data indicate that PCT might be a better marker than the classic criteria of inflammation, CRP, leukocyte count, and body temperature to identify patients endangered by severe infection or sepsis.

Are there new approaches for diagnosis, therapy guidance and outcome prediction of sepsis?

“…Although PCT-guided antibiotic therapy is associated with a reduction in antibiotic usage and may reduce overall costs of care, an increase in hospital mortality of 7% under PCT guided conditions could not be ruled out by a meta analysis of Heyland et al [33] . Despite the association of high PCT and CRP levels in the onset of sepsis with poor outcome [34,35] , the prognostic value of PCT is limited [10] .…”

Association of Serum Procalcitonin With Cardiovascular Prognosis in Coronary Artery Disease

“…1- 5 The increase of PCT concentrations in patients with sepsis correlates with mortality. 6 Experimental data have shown that PCT plays an important role during monocyte adhesion and migration, and further has a stimulatory effect on inducible nitric oxide synthase gene expression in patients with sepsis, representing key features of the atherosclerotic process. 7-9 Whereas an increasing number of studies have investigated the potential use of PCT in other infectious diseases such as pneumonia, bacterial meningitis and malaria, 10-12 only a few studies have been done on the impact of PCT on cardiovascular prognosis in patients with coronary artery disease (CAD).…”

Diagnostic Value of Determining the Level of Procalcitonin in the Practice of an Infectious Disease Specialist

“…К настоящему времени доказана корреляция уровня ПКТ с тяжестью синдрома полиорганной недостаточности [12]. В многочисленных исследованиях, преимущественно включавших пациен-тов с сепсисом, находившихся в отделении интенсивной терапии, продемонстрировали значительно более высо-кую прогностическую ценность повышения содержания ПКТ в отношении ТБИ в сравнении с концентрацией СРБ и числом лейкоцитов [13,14]. Интересно, что такого же повышения ПКТ в сыворотке крови почти не происходит при вирусных инфекциях, что, вероятно, связано с инги-бирующим действием интерферона ␥ на процессы выра-ботки ПКТ [15].…”