The Diagnostic And Prognostic Value Of Procalcitonin Level In Patients With Systemic Inflammatory Response Syndrome And Septic Shock Symptoms

Abstract

Despite new advancements in the diagnosis and treatment of sepsis, its mortality and morbidity is still high especially when complicated with shock and multiorgan disfunction. For that reason there is a need to have a specific and sensitive laboratory test which will guide the clinician for the accurate and early diagnosis of sepsis, for monitoring the effectiveness of treatment and deciding the accurate time to end treatment in order to avoid unnecessary treatment. In this study the diagnostic and prognostic value of PCT in patients with SIRS and septic shock symptoms were evaluated. A total of 94 patients, ages ranging between 22 and 75 with SIRS, sepsis, severe sepsis and septic shock symptoms were included in the study. They were followed for 14 days. PCT, CRP, erythrocyte sedimentation rates, peripheral blood leucocyte levels were recorded on the first day of the follow up period before the start of antibacterial treatment (T0), on the third day (T3), seventh day (T7) and tenth day (T10). The importance of PCT, CRP, erythrocyte sedimentation rates, peripheral blood leucocyte levels in the differential diagnosis of SIRS and sepsis and their prognostic value were evaluated. On T0 PCT and CRP levels were significantly different between the groups (p<0.001, p=0.046 respectively) but there were no significant difference in erythrocyte sedimentation rates and peripheral blood leucocyte levels between the groups (p=0.058, p=0.684 respectively). PCT levels were significantly high in all groups except in patients with SIRS. CRP levels were significantly higher in patients with septic shock than in patients with SIRS but there were no significant difference between the other groups. Patients who died during the follow up period were grouped as “died patients” and patients who were alive at the end of 14 days were grouped as “alive patients”. On T0, T3, T7 PCT levels were significantly higher in died patients than the alive patients (p<0.001, p=0.001, p=0.019 respectively). CRP and leucocyte levels were significantly different on T3 (p=0.03, p=0.02 respectively) but there were no significant difference on T0 and T7 between the two groups (respectively for CRP p=0.257, p=0.355, for leucocyte levels p=0.492, p=0.147). There were no significant difference in erytrocyte sedimentation rates at all times between the two groups (respectively p=0.942, p=0.403, p=0.621). When patients were finally assesed at the end of the follow up period, a significant decrease in PCT levels were observed in alive patients (p<0.001). In conclusion, we think that PCT is an important marker which guides the clinician in the differential diagnosis of sepsis and SIRS and when evaluating the prognosis.