Comparison of Procalcitonin and C-reactive Protein in Differential Diagnosis of Sepsis and Severe Sepsis in Emergency Department

Year 2017, Volume: 44 Issue: 2, 175 - 182, 07.06.2017

Ali Kemal Erenler Derya Yapar Özlem Terzi

https://doi.org/10.5798/dicletip.319750

Cited By: 2

Abstract

Objective: Sepsis and severe sepsis (sepsis accompanied by acute organ dysfunction) are leading causes of death
worldwide. In this study, our aim was to investigate utility of biomarkers commonly used in diagnosis of sepsis in
discriminating these two entities.
Methods: Two-hundred and three patients involved were divided into 2 subgroups as sepsis and severe sepsis
according to Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock:
2012. Then groups were compared according to clinical and laboratory (including C-reactive protein (CRP) and
procalcitonin (PCT) levels) characteristics.
Results: Of 203 patients included into the study, 124 (61.1%) were male and 79 (38.9%) were female. The most
common reason for sepsis was urinary tract infection (n=64, 31.5%), followed by catheter infection (n=16, 7.9%) and
pneumonia (n=14, 6.9%). Escherichia coli was the most common agent in both blood and urinary cultures. Majority of
the patients were treated with ceftriaxone (n=33, 16.3%), followed by meronem/dapson (n=25, 12.3%). In both
groups, CRP and PCT levels were high, even higher in severe sepsis group. However, any statistical significance could
not be determined between groups. Mortality rate in sepsis patients was 6.4%.
Conclusion: Plasma levels of both markers elevate in sepsis and severe sepsis. It was determined that CRP and PCT is
higher in severe sepsis than in sepsis. However, the difference is not statistically significant. Plasma levels of CRP and
PCT are not useful in differential diagnosis of sepsis and severe sepsis.

Keywords

C-reactive protein, procalcitonin, sepsis, severe sepsis

References

• 1. Vincent JL. We should abandon randomized controlled trials in the intensive care unit. Critical CareMedicine. 2010; 38: 534–8.
• 2. Protti A, Singer M. Bench-to-bedside review: potential strategies to protect or reverse mitochondrial dysfunction in sepsis-induced organ failure. Crit Care. 2006; 10: 228.
• 3. Liu B, Chen YX, Yin Q, et al. Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department. Crit Care. 2013; 17:R244.
• 4. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J. 1997; 16:735–47.
• 5. Gilbert DN. Use of plasma procalcitonin levels as an adjunct to clinical microbiology. J Clin Microbiol. 2010;48: 2325–9.
• 6. Dellinger RP, Levy MM, Rhodes A, Annane D. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013; 39:165-228.
• 7. Angele MK, Pratschke S, Hubbard WJ, et al. Gender differences in sepsis: cardiovascular and immunological aspects. Virulence. 2014;5:12-9.
• 8. Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014; 311: 844-54.
• 9. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5:4-11.
• 10. Yilmaz, G. R, Guven, T, Guner, R, et al. Growing fungal etiology in catheter-associated urinary tract infection: 2008-2013. IJID. 2014; 21:414.
• 11. Calandra T, Cohen J. The international sepsis forum consensus conference on defi¬nitions of infection in the intensive care unit. Crit Care Med. 2005; 33:1538–48.
• 12. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006; 34:344–53.
• 13. Martin-Loeches I, Levy MM, Artigas A. Management of severe sepsis: advances, challenges, and current status. Drug Des Devel Ther. 2015; 9:2079-88.
• 14. Bloos F, Reinhart K. Rapid diagnosis of sepsis.Virulence. 2014; 5:154-60.
• 15. Tang BM, Eslick GD, Craig JC, et al. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and metaanalysis. Lancet Infect Dis. 2007; 7:210-7.
• 16. Muller B, Becker KL, Schachinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000; 28:977–83.
• 17. Erenler AK, Yardan T. Presepsin (sCD14-ST) as a biomarker of sepsis in clinical practice and in emergency department: a mini review. Laboratoriums Medizin. DOI 10.1515/labmed-2015-0072.
• 18. Meijvis SC, Hardeman H, Remmelts HH, et al. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: A randomised, double-blind, placebo-controlled trial. Lancet. 2011; 377: 2023–30.
• 19. Gaieski DF, Edwards JM, Kallan MJ, et al.Benchmarking the incidence and mortality of severe sepsis in the united states. Critical CareMedicine. 2013;4: 1167–74.
• 20. Torio CM, Andrews RM. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011: Statistical Brief #160, Healthcare Cost and Utilization Project (HCUP) Statistical Briefs, Agency for Health Care Policy and Research, Rockville, Md, USA, 2006–2013.