The Clinical Research Of Early Diagnostic Value And Prognostic Significance Of Serum Procalcitonin In Patients With Sepsis

Objective:To investigate the early diagnostic value and prognostic significance of serum procalcitonin in patients with sepsis.1.Collected 90 cases from emergency medical center of Tianjin Medical University General hospital between 2008 December and 2009 Aprial.According to the sepsis diagnosis criteria, the cases were divided into sepsis group,non-infectious systemic inflammatory response syndrome(sirs) group and control group. Meanwhile, the sepsis group were divided into two subgroups(survival group and death group) according to 28-day mortality. Monitored the dynamic changes of procalcitonin,C-reactive protein,IL-6,IL-10,erythrocyte sedimentation rate (ESR),white blood cell(WBC),neutrophil percentage(N),platelet(PLT),body temperature(T) on the 1st and 3rd day after admission.Recorded the acute physiology and chronic health evaluation(APACHEⅡ) and sequential organ failure assessment (SOFA).2.PCT was measured by enzyme-linked fluorescent assay(ELFA),IL-6,IL-10 were measured by double-antibody sandwich ELISA,CRP level was measured by immunoturbidimetry.3.Statistical analysis:The test data were expressed as frequencies for nominal variables and as mean±SD or medians with interquartile range for continuous variables.The data were performed 1-K-S normal distribution test.One-way ANOVA was used for three groups when the data were normal,and LSD method was used between two groups comparison. Kruskal- Wallis H test was used for nonparametric distribution data. The univariate analysis was performed using t test for means, Mann- Whitney U test for medians and chi-square test for categorical variables. Spearman p (rs) was calculated to assess the correlation between biomarkers and APACHEⅡ,SOFA score. The diagnostic accuracy of the PCT was evaluated by ROC curves.Those variables with p values less than 0.05 on univariate anlysis were then entered into a multivariate logistic regression analysis to further identify the independent predictors of 28-day mortality and their adjusted odds ratios (OR) with 95% confidence intervals(95%CI). SPSS16.0,Medcalc11.3 softwares were used for statistical analysis, and a two-tailed P-value< 0.05 was considered significant.1.The serum procalcitonin of sepsis group on the 1 st day was higher than sirs and control groups; the area under ROC curve (AUC) of PCT was bigger than CRP,WBC,N,PLT,ESR and T.2.There was no differcnce of PCT level between Gram-negative bacterium and Gram-positive bacterium and bacterium and fungus.3.The PCT level of death group was higher than survival group on the 1st and 3rd day. (p=0.008, p=0.000,respectively)4.The PCT level of survival group gradually declined to normal level,but the death group did not significantly decrease.5.The PCT level of sepsis group on the 1st day positively correlated with APACHEⅡand SOFA. (r=0.487,p=0.000;r=0.508,p=0.00O,respectively).6.The AUC of SOFA,APACHEⅡ,PCT on the 1st and 3rd day were 0.934,0.891,0.767 and 0.967,0.729,0.550.7.The Logistic analysis showed SOFA was the independent predictor of 28-day mortality.1.The accuracy of serum PCT was superior to other inflammatory biomarkers in the early diagnosis of sepsis,and it was helpful to differentiate noninfectious systemic inflammatory response syndrome and sepsis.2.The serum PCT level could not help differentiate Gram-negative bacterium and Gram-positive bacterium and bacterium and fungus.3.The serum PCT level can reflect severity of sepsis,the higher the PCT level was,the severer the patient's condition was.4.Monitoring the dynamic changes of serum PCT level was useful to judge prognosis of sepsis patients, the higher the PCT level was,the worse the outcome was.And it could provide more clinical information when used with SOFA APACHEⅡscores together.