50 shades of grey: Does serum procalcitonin predict all cause mortality in patients with sepsis and septic shock?

Surg Cdr Manisha Thakur; Col KV Padmaprakash; Surg Capt A Chauhan; Lt Col Shashi Bhushan; Surg Cdr Rahul Tyagi; Surg Cdr Deep Kamal; Surg Lt Cdr Prashant Jambunathan

Volume : IX, Issue : IV, April - 2020

50 shades of grey: Does serum procalcitonin predict all cause mortality in patients with sepsis and septic shock?

Surg Cdr Manisha Thakur, Col Kv Padmaprakash, Surg Capt A Chauhan, Lt Col Shashi Bhushan, Surg Cdr Rahul Tyagi, Surg Cdr Deep Kamal, Surg Lt Cdr Prashant Jambunathan

Abstract :

Background The concept, definition and understanding of sepsis may have undergone several changes in the past years, but its omniscient nature in modern day critical care medicine has made accurate diagnosis, early initiation of therapy and relatively accurate prognostication, imperative. In recent times, procalcitonin has been used to initiate, de-escalate and guide antibiotic therapy. However, the data on its ability to predict all cause mortality in patients with sepsis remains nebulous. There is adequate evidence to merit considering both sides of the story. Methods We studied 99 consecutive patients meeting the diagnostic criteria for sepsis according to Sepsis 3 consensus criteria. Serum procalcitonin levels were compared head to head with 30-day all-cause mortality. Chi square paired and unpaired T and Pearson�s coefficient were used to analyze the data. Results Our study showed that patients with a higher baseline value of serum procalcitonin had higher rate of in-hospital mortality (SD – 1.8 vs SD - 0.68, 2-tailed P<0.001). However, no statistically significant association was noted between baseline PCT and duration of ICU stay. Conclusions The predictive value of serum PCT, for mortality has been a matter of debate and controversy with compelling evidence to both sides of the story available in contemporary literature. Our study re-enforces the dictum of early diagnosis and treatment of sepsis in conjunction with the judicious use of serum procalcitonin. On the horizon, the authors see a plethora of newer biomarkers (SUPAR and sTREM-1) which may be used standalone or in combination to improve outcomes.