[Value of procalcitonin in the early diagnosis of sepsis in Department of Emergency]

Hui-lin Liu, Gui-hua Liu, Qing-bian Ma
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, Chinese Critical Care Medicine, Zhongguo Weizhongbing Jijiuyixue 2012, 24 (5): 298-301

OBJECTIVE: To investigate the value of procalcitonin (PCT) in the early diagnosis and risk stratification in sepsis.

METHODS: Among 90 patients, 42 patients suffered sepsis, and 48 patients with severe sepsis. Serum PCT levels, high sensitivity C-reactive protein (hs-CRP), white blood cell (WBC) count, the percentage of neutrophils and lactate levels in sepsis and severe sepsis patients were determined. Receive operating characteristic curve (ROC curve) was drawn to evaluate the ability of PCT and related inflammatory parameters in assessing risk factors in patients with sepsis, and to analyze correlation between PCT and sequential organ failure assess (SOFA) score, WBC, lactic acid, and hs-CRP.

RESULTS: Compared with sepsis patients, among severe sepsis patients, the levels of PCT (μg/L), hs-CRP (mg/L), WBC [×10(9)/L] , and SOFA score were significantly higher (PCT: 7.228±2.153 vs. 0.172±0.165, hs-CRP: 102.68±90.99 vs. 29.05±28.76, WBC: 14.15±8.14 vs. 8.15±4.55, SOFA score: 9.87±2.47 vs. 3.09±1.55), with statistical significance (all P<0.01), and the levels of percentage of neutrophils and lactic acid (mmol/L) were slightly increased (percentage of neutrophils: 0.820±0.094 vs. 0.740±0.130, lactic acid: 1.47±0.99 vs. 1.18±0.60), with no statistical significance (both P>0.05). Analysis of ROC curve displayed that area under the curve (AUC) of PCT was 0.808, which was higher than that of WBC, percentage of neutrophils, lactic acid and hs-CRP (AUC was 0.124, 0.042, 0.551 and 0.262, respectively), and when PCT was 1.000 μg/L, the sensitivity was 80.3%, specificity was 72.2%, and they were better than those of other traditional markers of inflammation. Bivariate correlation analysis showed that a positive correlation was found between PCT and SOFA score and WBC [r1=0.418, P1=0.006; r2=0.251, P2=0.011], and there was no correlation between PCT and lactic acid and hs-CRP [r1=0.186, P1=0.155; r2=0.089, P2=0.133].

CONCLUSION: Serum PCT is a reliable measure in emergency room for early diagnosis of sepsis with high sensitivity and specificity, it could be used as a routine monitoring index in critically ill patients to help assess disease severity in sepsis.

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