Estimation of Serum Procalcitonin Levels in Patients with Sepsis
Keywords:
Procalcitonin, Sepsis, Patients, Infectious disease, DiagnosticAbstract
Introduction: Sepsis and SIRS share overlapping clinical features but differ fundamentally in their underlying pathophysiology. Both represent systematic inflammatory states; yet, the source and progression of immune activation diverge significantly between infectious and non-infectious etiologies. These differences become critical when attempting early diagnosis, where clinical science alone is insufficient, and biochemical markers, such as PCT, gain diagnostic relevance.
Aim: To determine the Day 1 serum Procalcitonin level in patients with sepsis and to assess the Day 1 serum procalcitonin concentration with duration of stay.
Materials and Methods: This research was designed as a prospective cohort study, which was conducted in the department of internal medicine at SGRRIM&HS and SMIH Dehradun on 150 patients of both genders above age 18 years with clinical evidence of heart failure who presented within 24-36 hours of illness with suspected sepsis and were admitted to the ICU. The study duration was 18 months. Serum procalcitonin was measured using a standard immunoassay method. Haematological tests, biochemical tests, and infectious disease tests were performed to confirm the specific infection. Chi-square tests and t-tests were performed for comparative analysis.
Results: A total of 150 patients [mean age was 34.2±8.1 years (18-40 years), mean age of 52.4±6.3 years (41-60 years), and mean age of 68.7±5.9 years (above 60)] were included in the study.
Higher PCT levels were associated with an increased mortality rate. The most significant mortality was observed in patients with PCT levels greater than 30 ng/mL, with 68% of the patients expiring, showing a strong and statistically significant association (p value = 0.001). A higher level of PCT was observed in patients with septic shock, suggesting that elevated PCT levels may be an indicator of septic shock in patients. 83.3% of patients had septic shock and expired, which indicates that septic shock is strongly associated with mortality (p-value = 0.03). PCT level also influences the ICU stay duration.
Conclusion: The study indicates that PCT serves as a diagnostic and monitoring tool, enabling clinicians to enhance patient care, reduce mortality associated with sepsis, and improve patient outcomes across various healthcare settings.
Downloads
References
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810. doi:10.1001/jama.2016.0287
Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, Angus DC, Reinhart K; International Forum of Acute Care Trialists. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med. 2016 Feb 1;193(3):259-72. doi: 10.1164/rccm 201504-0781OC. PMID: 26414292.
Divatia JV, Amin PR, Ramakrishnan N, Kapadia FN, Todi S, Sahu S, Govil D, Chawla R, Kulkarni AP, Samavedam S, Jani CK, Rungta N, Samaddar DP, Mehta S, Venkataraman R, Hegde A, Bande BD, Dhanuka S, Singh V, Tewari R, Zirpe K, Sathe P; INDICAPS Study Investigators. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med. 2016 Apr;20(4):216-25. doi: 10.4103/0972-5229.180042. PMID: 27186054; PMCID: PMC4859158.
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 Jun;34(6):1589-96. doi: 10.1097/01.CCM.0000217961.75225.E9. PMID: 16625125.
Schuetz P, Beishuizen A, Broyles M, Ferrer R, Gavazzi G, Gluck EH, González Del Castillo J, Jensen JU, Kanizsai PL, Kwa ALH, Krueger S, Luyt CE, Oppert M, Plebani M, Shlyapnikov SA, Toccafondi G, Townsend J, Welte T, Saeed K. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimised clinical use. Clin Chem Lab Med. 2019 Aug 27;57(9):1308-1318. doi: 10.1515/cclm-2018-1181. PMID: 30721141.
Meisner, M. (2010). Procalcitonin – Biochemistry and clinical diagnosis (1st ed.). UNI-MED Science. ISBN 978-3-8374-1241-3 (Germany) / ISBN 978-1-84815-163-5
Jujjuru, S., Panduranga, G., & Kanugula, S. (2022). Serum procalcitonin correlation with sepsis severity and patient outcomes: An observational study. Journal of Clinical and Diagnostic Research, 16(11), OC20–OC23. https://doi.org/10.7860/JCDR/2022/60163.17128
Mustafić S, Brkić S, Prnjavorac B, Sinanović A, Porobić Jahić H, Salkić S. Diagnostic and prognostic value of procalcitonin in patients with sepsis. Med Glas (Zenica). 2018 Aug 1;15(2):93-100. doi: 10.17392/963-18. PMID: 30047536.
Xue H, Yu F. Changes in Heparin-Binding Protein, Procalcitonin, and C-Reactive Protein Within the First 72 Hours Predict 28-Day Mortality in Patients Admitted to the Intensive Care Unit with Septic Shock. Med Sci Monit. 2023 Jan 25;29:e938538. doi: 10.12659/MSM.938538. PMID: 36694437; PMCID: PMC9885725.
AlRawahi AN, AlHinai FA, Doig CJ, Ball CG, Dixon E, Xiao Z, Kirkpatrick AW. The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review. Crit Care. 2019 Dec 3;23(1):390. doi: 10.1186/s13054-019-2669-1. PMID: 31796098; PMCID: PMC6892215.
Spoto S, Nobile E, Carnà EPR, Fogolari M, Caputo D, De Florio L, Valeriani E, Benvenuto D, Costantino S, Ciccozzi M, Angeletti S. Best diagnostic accuracy of sepsis combining SIRS criteria or qSOFA score with Procalcitonin and Mid-Regional pro-Adrenomedullin outside ICU. Sci Rep. 2020 Oct 6;10(1):16605. doi: 10.1038/s41598-020-73676-y. PMID: 33024218; PMCID: PMC7538435.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
