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Abstract
Background
Early recognition and treatment of sepsis would improve patients' outcome. But it is difficult to distinguish between sepsis and non-infectious conditions in the acute phase of clinical deterioration. We studied serum level of procalcitonin (PCT) as a method to diagnose and to evaluate sepsis.
Methods
Between 1 March 2009 and 30 September 2009, 178 patients had their serum PCT tested during their clinical deterioration in the medical intensive care unit. These laboratories were evaluated, on a retrospective basis. We classified their clinical status as non-infection, local infection, sepsis, severe sepsis, and septic shock. Then, we compared their clinical status with level of PCT.
Results
The number of clinical status is as follows: 18 non-infection, 33 local infection, 39 sepsis, 26 severe sepsis, and 62 septic shock patients. PCT level of non-septic group (non-infection and local infection) and septic group (sepsis, severe sepsis, septic shock) was 0.36±0.57 ng/mL and 18.09±36.53 ng/mL (p<0.001), respectively. Area under the curve for diagnosis of sepsis using cut-off value of PCT >0.5 ng/mL was 0.841 (p<0.001). Level of PCT as clinical status was statistically different between severe sepsis and septic shock (*severe sepsis; 4.53±6.15 ng/mL, *septic shock 34.26±47.10 ng/mL, *p<0.001).
Figures and Tables
Figure 1
Mean values±SD of PCT in patients with non-infection (n=18), local infection (n=33), sepsis (n=39), severe sepsis (n=26), septic shock (n=62) at their clinical deterioration (1st ICU day). *p<0.001. SD: standard deviation; PCT: procalcitonin.
Figure 2
Diagnostic performance of procalcitonin for diagnosis of sepsis. Using cut-off value of procalcitonin >0.5 ng/mL for diagnosis of sepsis, area under curve (AUC) is 0.841 (95% confidence interval, 0.776~0.907, p<0.001). ROC: receiver operating charateristic; PCT: procalcitonin.
Figure 3
Serum PCT measurment, APACHE IIscore and SOFA score as a predictor of short-term (28 days) mortality in critically ill patients: area under ROC-AUC with 95% CI and p-value (PCT 0.583: 95% CI, 0.495~0.671; p=0.074; APACHE 0.673: 95% CI, 0.589~0.756; p<0.001; SOFA 0.703: 95% CI, 0.619~0.787; p<0.001). PCT: procalcitonin; APACHE: acute physiology and chronic health evaluation; SOFA: sequential organ failure assessment; ROC: receiver operating curve; AUC: area under curve; CI: confidence interval.
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