PROCALCITONIN
AS A
BIOMARKER
OF
INFECTION
IN PATIENTS
WITH SIRS/ SEPSIS
Sepsis
is
defined
as
systemic
inflammatory
response
syndrome
(SIRS)
in
the
presence
of
an
underlying
infectious
process,
and
is
associated
with
high
rates
of
morbidity
and
mortality
particularly
when
initial
therapy
is
delayed
.
Procalcitonin
is
currently
the
most
studied
infection
biomarker
and
its
blood
levels
seem
to
mirror
the
severity
of
illness
and
outcome
.
PCT
may
help
in
discriminating
bacterial
from
viral
infections
and
true
bacteremia
from
contaminated
blood
cultures
.
Divyani
Gupta
,
Deepinder
Chhina
, H.S.
Dhooria
, Rama Gupta
Department of Microbiology,
Department of
Medicine, Dayanand
Medical College & Hospital, Ludhiana
PCT
as
a
biological
marker
appears
to
have
a
significant
value
in
identifying
or
ruling
out
an
infection
.
Assessing
severity
of
the
disease
primarily
for
triaging
decisions
.
Monitoring
response
to
therapy
(requires
serial
PCT
measurements)
PCT
may
be
of
value
to
distinguish
gram
negative
from
gram
positive
and
fungal
infections
.
The
future
lies
with
more
research
focused
on
the
use
of
panels
or
combination
of
markers
.
To
correlate
Procalcitonin
levels
with
blood
culture
in
SIRS/
sepsis
INTRODUCTION
OBJECTIVE
RESULTS
100
cases
of
SIRS/sepsis
according
to
1992
ACCP/SCCM
Sepsis
definitions
were
included
in
the
study
.
Out
of
total
100
cases,
87
had
PCT
value
>=
0
.
5
ng
/ml
whereas
13
had
PCT
value
of
<
0
.
5
ng
/ml
.
Infective
foci
were
seen
in
85
%
(
74
/
87
)
of
patients
with
PCT
levels
of
>=
0
.
5
ng/ml
.
Blood
culture
positivity
in
moderate
SIRS
(PCT
-
>=
0
.
5
-
<
2
ng
/ml),
severe
sepsis
(PCT
-
2
-
<
10
ng
/ml)
and
septic
shock
(PCT
-
>=
10
ng
.
ml)
were
31
.
8
%
,
30
.
7
%
and
57
.
6
%
respectively
.
Higher
values
of
PCT
were
observed
in
gram
negative
septicemia
(average
mean
-
26
.
9
ng
/ml)
as
compared
to
gram
positive
septicemia
(
20
.
4
ng
/ml)
or
fungal
(
Candida
spp
.
)
septicemia
(
2
.
14
ng
/ml)
.
Clinically
suspected
cases
of
sepsis
admitted
in
medical
ICUs
were
included
in
the
study
.
Procalcitonin
levels
were
measured
by
automated
system
based
on
electrochemiluminescence
(ECL)
technique
.
Blood
samples
were
collected
and
processed
in
the
BacTec
/
Bac
-
T/Alert
Microbial
Detection
System
.
Growth
was
identified
and
antimicrobial
sensitivity
testing
was
done
in
VITEK
2
system
as
per
CLSI
guidelines
.
METHODS
CONCLUSIONS
Correlation of PCT with etiology of infections
PCT
<0.5ng/ml
>=0.5
-
<2
ng
/ml
>=2
-
<10
ng
/ml
>=10
ng
/ml
Total number of
patients (100)
13
22
39
26
Infective focus
(viral/fungal/bac
terial)
6
20
28
26
Bacterial focus
(except BSI)
-
6
14
11
Bloodstream
infections
2
7
12
15
Fungal etiology
(except
Candidemia
)
-
6
(Aspergillosis
-
5,
Cryptococcosis
-
1)
2
(Aspergillosis
-
2)
-
Viral etiology
4
1
-
-
Clinical diagnosis of patients with PCT value >=0.5
ng
/ml (n= 87)
No. of patients
Infected
74
Bloodstream infections
Pneumonia, empyema, lung abscess
Urinary tract infections
Upper respiratory tract infections
Wound and soft tissue infections
Biliary tract infections and
cholecystitis
Appendicitis (positive
ascitic
fluid culture)
Nocardiosis
Leptospirosis
Scrub typhus
Aspergillosis
Cryptococcosis
Herpes simplex viral infection
34
11
8
4
1
1
2
1
1
2
7
1
1
Non
-
Infected
13
PCT concentrations and blood culture growth obtained
PCT
<0.5
ng
/ml
>=0.5
-
<2
ng
/ml
>=2
-
<10
ng
/ml
>=10
ng
/ml
Blood culture
positive
2
7
12
15
Blood culture
growth obtained
E. coli
(1
)
C
.
tropicalis
(
1
)
E.coli
(1
)
Acinetobacter
baumannii
(
1
)
Pseudomonas
aeruginosa
(1
)
E
.
faecium
(
1
)
CONS
(2
)
C
.
tropicalis
(
1
)
Klebsiella pneumoniae
(4
)
E
. coli
(3),
Enterobacter
cloacae
(1
)
S. aureus
(
1
)
E
.
faecium
(
1
)
C
.
albicans
(
2
)
E. coli
(5
)
Klebsiella
pneumoniae
(
4
)
Pseudomonas
aeruginosa
(2
)
E
.
faecium
(
1
)
S
.
aureus
(
1
)
CONS
(2
)