Procalcitonin Versus C-Reactive Protein at Different SOFA Scores in I.C.U. Sepsis: Diagnostic Value and Therapeutic Implications
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- Category: Vol. 82, March 2014
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Procalcitonin Versus C-Reactive Protein at Different SOFA Scores in I.C.U. Sepsis: Diagnostic Value and Therapeutic Implications, SAMEH EL MARAGHI, AHMED YEHIA, OSAMA MAHMOUD and ALIAA ABD EL HAMID
Abstract
Introduction: Procalcitonin is a pro-hormone of calcium homeostasis released by many tissues during infection and is probably a part of abnormal systemic response that leads to severe sepsis. CRP produced by hepatocytes, predominantly under control of cytokine IL-6, may provide an early indication of developing SIRS with progression to sepsis that is more sensitive than the standard clinical criteria of infection.
Objective: To compare the impact of PCT and CRP in the diagnosis and prognosis of sepsis at different SOFA scores.
Methods: A prospective study conducted on 25 patients divided into group I, (14 patients) who were diagnosed as SIRS, sepsis, severe sepsis or septic shock with organ affection; and group II, (11 patients) diagnosed as SIRS and sepsis but without organ affection. APACHE II score on admission and SOFA score every day were applied. Procalcitonin was mea-sured by in-vitro ELISA technique and CRP by rapid latex agglutination test on 1st, 5th and on discharge or day of death. Ten healthy individuals served as controls.
Results: Septic patients had statistically significant high PCT & CRP levels (6.349±4.95 vs. 0.299±0.184ng/ml; p<0.001 and 28.36±16.342 vs. 12±6.914mg/l; p=0.003); however; PCT was significantly higher in group I than in group II (8.09±4.04 vs. 0.320±0.132ng/ml; p<0.005), while CRP was not (36± 13.856 vs. 41.45±23.61ng/ml; p=0.677). Moreover; there were a statistically significant difference in PCT levels between survivors (18pts.) and non-survivors (7pts.) on 1st day (3.317± 3.978 vs. 9.740±4.847ng/ml; p=0.002), 5th day (0.7858±0.907 vs. 10.608±4.592; p=0.001) and on discharge or the day of death (0.2951±0.195 vs. 15.920±2.769; p<0.0001) while there were no differences in CRP between survivors and non-survivors.
Conclusion: PCT is prognostically superior to CRP for its strong correlation with mortality & significant correlation to both SOFA and APACHE II scores. PCT plays a diagnostic as well as prognostic role in systemic sepsis, while CRP had a diagnostic role only but does not serve as a prognostic marker in sepsis.