The Value Of Procalcitonin At Early Diagnosis And Predicting The Severity Of Sepsis In Critical Patients

Objective: To discuss the value of procalcitonin in assessing the severity of disease and early prediction in sepsis patients.Methods: Retrospective analysis 1650 patients that plasma PCT and CRP were determined, together with the leukocyte count upon admission to the ICU in Wannan Medical Yijishan Hospital from August 2012 to February 2013.With reference to systemic inflammatory response syndrome and sepsis diagnostic criteria and exclusion criteria, 243 patients was selected in this study. In accordance with the classification criteria, the 243 patients were classified into four groups: systemic inflammatory response syndrome group(S group), early sepsis group(ES group), severe sepsis group(SS group) and septic shock group(SSH group).Compare the level of PCT, WBC and CRP of each group and analyze the relevance, then the diagnostic accuracy of the markers was made using ROC(receiving operator characteristic) curve analysis, calculating the area under the curve(AUC). Evaluating the value of PCT, WBC and CRP in the diagnosis of sepsis.Results:(1) The demographic characteristics of each group of patients: the sex ratio, age and risk factors of each group have no statistically significant(P> 0.05). The APACHEâ…¡score of SS group and SSH group are much higher than that of S group(P< 0.05).(2) The median and quartiles of WBC, CRP and PCT is 8.40(4.60, 13.10), 69.22(29.02, 127.87), 0.05(0.05, 0.96) respectively. The level of WBC, CRP and PCT in ES group, SS group and SSH group are much higher than that in S group(P<0.05).(3) Spearman correlation analysis showed that, CRP and PCT are positively correlated with systemic inflammatory response syndrome and various types sepsis, r s values were 0.390,0.488. No correlation with the WBC.(4) The value of CRP in early diagnosis of sepsis is superior to PCT and WBC. The area under the curve of CRP, PCT, WBC is 0.678, 0.659, 0.576 respectively.(5) The value of PCT in predicting of sever sepsis is higher than CRP, The area under the curve of which is 0.830, 0.729 respectively. The threshold value of PCT and CRP in predicting of severe sepsis is 3.845ng/m L and 108.500mg/L, respectively. the diagnostic sensitivity was 88.24% when PCT combined with CRP in the diagnosis ofsevere sepsis, higher than that of single use of PCT(72.50%) or CRP(62.70%).Conclusion:(1) PCT and CRP level can be used as a maker in diagnosis of sepsis, and positively correlated with sepsis classification, the value of CRP in early diagnosis of sepsis is better than that of PCT.(2) The value of PCT in predicting of sever sepsis is superior to CRP.(3) PCT combined with CRP can be used as indicators in diagnosis and evaluating sepsis, cut-off values being individually 3.845 ng/m L and 108.500 mg/L, which increase the diagnostic sensitivity and act as a indicator for clinical physician in assessing the degree of sepsis.