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Volume 5 Issue 6 (June, 2017)

Original Articles

CORRELATION BETWEEN PCT LEVELS AND STAGE OF SEPSIS AMONGST PATIENTS PRESENTING IN A TERTIARY CARE HOSPITAL- A PROSPECTIVE STUDY
Harminder Singh Pannu, Surinder Pal Singh, Dapinder Kaur Chinna, Shaminder Kaur, Manpreet Kaur Jhinger, Jatinder Pal Singh, Gurpreet Singh

Background: Sepsis is a common and serious disease with substantial morbidity and mortality despite recent advances in supportive care and disease-specific treatments. There is no specific diagnostic test for the septic response. Even the bacteriological evidence of infection is not sensitive enough. The initial phase of the care of patients with sepsis (the so called “golden hours”) is considered critical; timely hemodynamic support, along with administration of appropriate antibiotic treatment has been demonstrated to improve survival and significant clinical end points. The first mention of Procalcitonin in sepsis appeared  in the report of 1983 mentioning its elevated levels in toxic shock syndrome (TSS) caused by staphylococcal aureus. The aim of the present study is to determine PCT levels amongst patients with sepsis, severe sepsis and septic shock presenting in a tertiary care hospital. Materials and methods: The present prospective study was conducted in the Department of Medicine Dayanand Medical College and Hospital Ludhiana during a period from 1st January 2013 to 1 February 2014.Details of the patients including: name, age, sex, admission number, data of admission, central record number etc were noted and all the symptoms were recorded. Relevant past history like diabetes, hypertension, COPD, recent surgery etc. was noted. Specimen of blood (10ml) was obtained from each patient by aseptic technique and was inoculated into commercially prepared Bactec/  Bac-T/Alert vials at the bedside. Procalcitonin was measured with VIDAS (ELFA) technique. The detection limit of the assay is 0.1 ng/ml and procalcitonin levels of healthy subjects are usually <0.1 ng/ml. Data were analysed using SPSS software version 18. p value <0.05 was considered as statistically significant. Chi square test was used to compare these variables. Procalcitonin values were analysed and presented in terms of Median with interquartile range since the data were not uniformly distributed. Kruscal Wallies test was used to compare median procalcitonin between the three groups of sepsis. Mann Whitney U test was used were two variables are present. Result: A total of 102 consecutive patients who satisfied the inclusion criteria were enrolled in the study. There were 39 patients (38.2%) had sepsis, 43 patients (42.2%) had severe sepsis and 20 patients (19.6%) were in septic shock. Out of the total 102 patients, 45 patients (44.11%) were categorized as having severe bacterial SIRS, 31 patients (30.39%) had severe SIRS, while 15 patients (14.70%) had moderate SIRS. Out of the total number of patients, in normal group there were 7 males (63.63%) & 4 females  (36.36%), in the moderate SIRS group there were 12 males  (80%) & 3 females  (20%), in the severe SIRS group there were  21 males (67.64%) & 10 females (32.25%) and in the severe Bacterial SIRS there were 30 males (66.66%) & 15 females (33.33%).The median PCT value in the sepsis group was 2.56 ng/ml, in the severe sepsis group was 9.3  ng/ml  and in the septic shock group was 17.5  ng/ml. p value was significant. The PCT value was more in the septic shock group (68.18%) and the    severe sepsis group (45.45%) as compared to the sepsis group (27.77%). p value is  0.015 which was significant suggesting that  rising level of  PCT correlated with the severity of sepsis. Conclusion: Median value of serum procalcitonin in the group of patients with sepsis was 2.56 ng/ml, in the group of severe sepsis was 9.3 ng/ml and in the group of patients with septic shock it was 17.5 ng/ml. Serum procalcitonin done once at the time of admission was proven to be very good, cost effective biomarker for the early identification of sepsis better than the traditional system of blood or body fluid cultures.
Keywords: Bacteriological, Golden Hours, Procalcitonin, Sepsis.

 
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