The Significance Of Serum Procalcitonin In The Diagnosis And Prognosis Of Burn Sepsis

Research background and objectives:Burn is an open type pathological damage. Because the skin of patients is damaged,pathogenic microorganisms can easily colonize on burn wounds then propagate and invadethe body. The wet and warm burn wounds become good culture medium for the growth andreproduction of bacteria, and the immune function of severely burned patients is decrease,these are the contributing factors for the occurrence of burn sepsis[1]. So burn sepsis is animportant complication in patients with severe burns, and the successfully treatment of burnsepsis is the key to success in rescue of burn patients. Symptoms of systemic inflammatoryresponse (SIRS) easily occurs in patients with extensive burns, which is similar to burninfection and makes it extremely difficult to diagnose burn sepsis early in clinic. Althoughbacterial culture of blood samples plays an important role in the diagnosis of burn sepsis,the lower positive rate and long time to separating pathogenic bacterium make it difficult toprovide an early diagnosis. So a simple and rapid detection method is needed for the earlydiagnosis and prognosis.When there is a local infection or virus infection, the serum PCT levels were notincreased or increased a little. But the serum PCT levels were significantly increased after2-3hours of systemic infection or serious bacterial infection. Therefore, serum PCT showedgood sensitivity and specificity to bacterial infection. And serum PCT levels are positivelycorrelated with the severity of bacterial infection, the levels can reduce to normal aftercontrolling infection. So serum PCT can be used as a reliability index for the earlydiagnosis and prognosis of burn sepsis.The present study intends to discuss the significance of serum PCT levels in thediagnosis and prognosis of burn sepsis. This paper includes three parts: the first partevaluated the predictive effect of serum PCT on burn sepsis in burn shock stage, the secondpart summarized the effect of serum PCT levels on diagnosis of burn sepsis, the third part analyzed the effect of serum PCT levels on the prognostic of burn sepsis, to providedefining characteristics for the treatment of sepsis patients with extensive burns.Materials and methodsA total of60cases with TBSA>50%,16-65years old, from December2011toSeptember2013in the burn research institute of southwest hospital, the third militarymedical university were enrolled in this study. Serum PCT examinations were determined.The following three parts were selected from these cases according to their inclusioncriteria.1. The predictive effect of serum PCT on burn sepsis in burn shock stage42burn patients on admission and underwent serum PCT determination within48hours were enrolled. Patients were divided into sepsis group (n=19) and non-sepsis group(n=23) according to the their conditions. General information such as gender, age, burnarea, deep second degree burn area and the third degree burn area were recorded. The bloodparameters (WBC, Neut%, GLU, ALT, TBA, TBIL, Cr, NA), APACHE Ⅱ score andserum PCT of patients in two groups during the burn shock stage were also recorded.2.The effect of serum PCT levels on diagnosis of burn sepsis.34burn patients underwent serum PCT determination every1-5days were enrolled.Patients were divided into sepsis group (n=18) and non-sepsis group (n=16) according tothe their conditions. General information such as gender, age, burn area, deep seconddegree burn area and the third degree burn area were recorded. Compared blood indicators(WBC, Neut%, PLT, ALT, TBA, Cr, NA, GLU) when patients on admission and the serumPCT value after1-5days,6-10days,11-15days,16-20days,21-25days and26-30days intwo groups.3.The effect of serum PCT levels on the prognostic of burn sepsis.28burn patients diagnosed as burn sepsis and underwent serum PCT determinationwere enrolled, deep second degree burn area and the third degree burn area>50%,thenunderwent serum PCT determination every2-3days after burn. Patients were divided intothe non-survivors septic group (n=12) and the survivors septic group (n=16) according tothe prognosis of patients. General information such as gender, age, burn area, deep partialthickness burn area and the third degree burn area were recorded. Compared bloodindicators (WBC, Neut%, PLT, ALT, TBA, Cr, Na, GLU) and APACHE Ⅱ score when patients diagnosed as burn sepsis. Compared the serum PCT value when patients diagnosedas burn sepsis and after1-4days,5-8days of the diagnosis.Statistical analysis of the data in these three parts were the t test, χ2test, nonparametricmethod (rank sum test) and (Keuskal Wallis) statistical analysis, and draw ROC curve.Results and conclusion1. The predictive effect of serum PCT on burn sepsis in burn shock stageThere was no difference between the general information of sepsis group andnon-sepsis group（p>0.05）,and there was no difference between the blood parameters（WBC、Neut%、PLT、ALT、TBA、Cr、NA、GLU） and APACHE Ⅱ score of patientsin two groups during the burn shock stage（p>0.05）. The serum PCT tests revealed that thePCT level of non-sepsis group （1.91±2.60ng/mL）was significantly lower than that in thesepsis group（21.57±42.99ng/mL）during the burn shock stage, there were significantdifference between two groups (Z=-3.715, P <0.01). The area under ROC curve (AUC) ofPCT level during the burn shock stage was0.836（95％CI0.714-0.959，P<0.0001），theOptimal threshold was5.00ng/mL, at this point,the sum of its sensitivity and specificity todiagnose was the largest,, which were68.4％and87.0％respectively. The effect ofserum PCT on burn sepsis in burn shock stage is very important.2.The effect of serum PCT levels on diagnosis of burn sepsis.There was no difference between the general information of sepsis group and non-sepsisgroup（p>0.05）,and there was no difference between the blood parameters（WBC、Neut%、PLT、ALT、TBA、Cr、Na、GLU）of patients in two groups on admission（p>0.05）. Theserum PCT value after1-5days,6-10days,11-15days,16-20days,21-25days and26-30days in the sepsis group（25.67±40.65ng/mL、9.98±8.26ng/mL、8.11±13.61ng/mL、12.52±20.69ng/mL、9.31±14.20ng/mL、12.55±18.29ng/mL）were all higher than that inthe non-sepsis group（1.10±1.17ng/mL、1.09±1.63ng/mL、0.92±0.99ng/mL、2.69±9.16ng/mL、0.26±0.37ng/mL、0.09±0.11ng/mL）.The serum PCT levels can be used as animportant indicator for the diagnosis of burn sepsis.3.The effect of serum PCT levels on the prognostic of burn sepsis.There was no difference between the general information in the non-survivors septicgroup and the survivors septic group（p>0.05）,and there was no difference between theblood indicators (WBC, Neut%, PLT, ALT, TBA, Cr, NA, GLU) and APACHE Ⅱ score when patients diagnosed as burn sepsis（p>0.05）.Compared the serum PCT value whenpatients diagnosed as burn sepsis and after1-4days,5-8days of the diagnosis, the values ofnonsurvivors septic group were significantly higher than that in the survivors septic group(Z=-4.364~-2.955, P <0.01). The total area under ROC curve (AUC) of PCT level ofdead prediction in28patients with burn sepsis were0.990，the Optimal threshold was10.8700ng/mL.The sensitivity of dead prediction was91.7%, specitieity was100%. Theserum PCT levels can be used as an important indicator for the prognosis of burn sepsis.