Procalcitonin: A unique marker to evaluate the severity of sepsis among diabetic patients

Abstract

Introduction: Diabetes mellitus (DM) is considered one of the largest emerging threats to health and bacterial infections are more frequent in diabetic patients causing sepsis. Several indicators have been proposed as new diagnostic tests to assess sepsis in hospitalized patients. Aim: This study aims was to compare the efficacy of Procalcitonin (PCT) and high sensitive C-reactive protein (hs-CRP) in the diagnosis of sepsis in diabetic patients. Methods: In this cross-sectional study total of 60 age and sex-matched diabetic patients above 18 years were randomly chosen with at least 2 SIRS (Systemic inflammatory response syndrome) criteria from the indoor department of BIRDEM General Hospital. Basic hematological, biochemical, microbiological laboratory data were recorded from laboratory reports. Sepsis and its different stages were determined according to American College of Chest Physicians (ACCP) guidelines. The PCT was measured by sandwich enzyme immunoassay (Bio-Vendor, Germany) and the hs-CRP level was measured using an immune-turbidimetric assay (Beckman, Carlsbad, CA 92010, USA). Results: The patient’s mean age was 51.90±9.89 years where male 51.2% and female 48.8% and 50-60 years age group was the most common 40%. 38 (63.33%) patients were bacteriological culture-positive and 22 (36.67%) patients were bacteriological culture-negative where the most common organism was Klebsiella (28.95%). Statistically, a significant difference was found in PCT values in the bacteriological culture positive and negative group (p<0.05), but there was no significant difference found in hs-CRP values (p>0.05). There was an increasing trend of serum PCT with the developing stages of sepsis. Receiver operating characteristic curve shows the area under the curve for PCT was 0.785 (95% CI; 0.654-0.915), sensitivity 89.47%, specificity 50%, PPV 75.55% and NPV 73.33% with the best cut-off value >753pg/ml which support PCT as a superior and reliable marker of sepsis. Conclusion: Our results suggest that serum PCT is a more reliable diagnostic marker of sepsis than other traditional markers like hs-CRP. Combinatorial use of these biomarkers will help in early diagnosis and also greatly improve outcomes. Bangladesh Crit Care J March 2022; 10 (1): 38-42

Red Blood Cell Distribution Width Level as Reliable Diagnostic and Prognostic Biomarker in Septic Patients: A Case-Control Study

“…Furthermore, CRP levels were substantially higher in the dead compared to survivors on the first day (96.70 ± 22.53 vs. 39.41 ± 9.62 mg/l), third (123.5 ± 30.17 vs. 26.88 ± 6.53 mg/l) (p 0.001), and seventh day after admission (158.51 ± 32.18 vs. 22.11 ± 5.43 mg/l), < 0.001. Whereas procalcitonin level was significantly higher in dead patients than in survivors on the first, third, and seventh days after admission, p < 0.0001, Table (6). On day 1 (r = 0.549, p < 0.0001) and day 3 (r = 0.586, p < 0.0001) post IUC-admit, the RDW and Sequential Organ Failure Assessment (SOFA) scores were moderately positively correlated.…”

“…Additionally, the CRP cut-off point (CRP > 38.7 mg/l) with 94.5% sensitivity and 90.4% specificity, and the procalcitonin > 2.2 mg/l with 98.8% sensitivity and 98.8% specificity was also correlated with sepsis development following admission to the ICU, as presented in Table (5). As shown in Table (6), the overall incidence of mortality on the seventh day of admission to the ICU was 43.5% and 13.1% in the septic and control groups, respectively, with a highly significant difference (p < 0.001) between both groups. Table (6) also showed the distribution of RDW, CRP, and procalcitonin according to survival in both studied groups; RDW was significantly higher in dead patients than in survived patients in the first (18.33 vs. 14.05), third (20.38 vs. 14.3), and seventh days after admission (26.65 vs. 17.11), p< 0.001.…”

“…As shown in Table (6), the overall incidence of mortality on the seventh day of admission to the ICU was 43.5% and 13.1% in the septic and control groups, respectively, with a highly significant difference (p < 0.001) between both groups. Table (6) also showed the distribution of RDW, CRP, and procalcitonin according to survival in both studied groups; RDW was significantly higher in dead patients than in survived patients in the first (18.33 vs. 14.05), third (20.38 vs. 14.3), and seventh days after admission (26.65 vs. 17.11), p< 0.001. Furthermore, CRP levels were substantially higher in the dead compared to survivors on the first day (96.70 ± 22.53 vs. 39.41 ± 9.62 mg/l), third (123.5 ± 30.17 vs. 26.88 ± 6.53 mg/l) (p 0.001), and seventh day after admission (158.51 ± 32.18 vs. 22.11 ± 5.43 mg/l), < 0.001.…”

“…There are no gold standards for the diagnosis of infection; however, procalcitonin is regarded as one of the most potential sepsis indicators in critically ill patients (6) , complementing clinical symptoms and routine laboratory variables that predict sepsis but remain costly (7) .…”

“…Most RDW studies are used mainly to identify the type of anemia (6) . Research has found that, in addition to the evaluation of anemia, RDW is identified as a prognostic factor for disease severity and clinical outcomes in various diseases, including acute myocardial infarction (MI) (12) , acquired pneumonia (13) , and pulmonary embolism (14) .…”