Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia

Introduction: During infection, there is increased expression of CALC-I gene resulting in ubiquitous release of procalcitonin (PCT). Since the expression of PCT is dependent on the genetic constituents of a population, this study aimed to validate the diagnostic performance of PCT in differentiating...

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Main Authors:	Mat Nor, Mohd Basri, Md Ralib, Azrina, Mohamed, Abdul Hadi, Abdullah, Nor Zamzila
Format:	Article
Language:	English
Published:	Ministry of Health and Universiti Brunei Darussalem 2013
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/32164/ http://irep.iium.edu.my/32164/ http://irep.iium.edu.my/32164/1/BIMJ201394243.pdf

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spelling	iium-321642017-04-06T08:18:26Z http://irep.iium.edu.my/32164/ Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia Mat Nor, Mohd Basri Md Ralib, Azrina Mohamed, Abdul Hadi Abdullah, Nor Zamzila R Medicine (General) Introduction: During infection, there is increased expression of CALC-I gene resulting in ubiquitous release of procalcitonin (PCT). Since the expression of PCT is dependent on the genetic constituents of a population, this study aimed to validate the diagnostic performance of PCT in differentiating sepsis from noninfectious systemic inflammatory response syndrome (SIRS) in a Malaysian intensive care unit (ICU). Materials and Methods: Ninety-five patients fulfilling the criteria for SIRS were enrolled. Daily concentrations of PCT, C-reactive protein (CRP) and white cell count (WCC) were measured over three days. The diagnostic and predictive performance of these biomarkers were assessed using area under the curve of the ROC. Results: In this study, medical and surgical cohorts had similar PCT concentrations. Peak (p=0.02) and daily PCT (p<0.001) concentrations were significantly higher in patients with sepsis compared to SIRS. There were no significant differences in the CRP and WCC concentrations between the two groups. Peak PCT was significantly higher in patients with bacteraemia than those without (49.1 [19.3- 57] vs. 6.9 [1.1-25.6 ng/ml], p=0.001). PCT was diagnostic of sepsis and bacteraemia (AUC of 0.73 [0.64-0.83] and 0.80 [0.66-0.93] respectively). Peak PCT was significantly higher in septic patients with culture positive compared to culture negative (p=0.02). At the optimal cut-point of 10.68 ng/ml for peak PCT, sepsis was very likely with specificity of 86% and psotive predictive value (PPV) of 91%. There was a good correlation between PCT concentration and the Sequential Organ Failure Assessment (SOFA) score in the sepsis cohort (r=0.62, p<0.0001). Conclusion: PCT was better than CRP or WCC in differentiating sepsis from non-infectious SIRS in critically-ill patients. PCT is diagnostic of sepsis and bacteraemia, and is also useful as an indicator of severity of organ failure in sepsis. Ministry of Health and Universiti Brunei Darussalem 2013-08 Article PeerReviewed application/pdf en http://irep.iium.edu.my/32164/1/BIMJ201394243.pdf Mat Nor, Mohd Basri and Md Ralib, Azrina and Mohamed, Abdul Hadi and Abdullah, Nor Zamzila (2013) Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia. Brunei International Medical Journal, 9 (4). pp. 243-252. ISSN 2079-3146 (O), 1560-5876 (P) http://www.bimjonline.com/Abstract/BIMJ%202013%20Volume%209,%20Issue%204/MatNor201394243252.htm
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Mat Nor, Mohd Basri Md Ralib, Azrina Mohamed, Abdul Hadi Abdullah, Nor Zamzila Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia
description	Introduction: During infection, there is increased expression of CALC-I gene resulting in ubiquitous release of procalcitonin (PCT). Since the expression of PCT is dependent on the genetic constituents of a population, this study aimed to validate the diagnostic performance of PCT in differentiating sepsis from noninfectious systemic inflammatory response syndrome (SIRS) in a Malaysian intensive care unit (ICU). Materials and Methods: Ninety-five patients fulfilling the criteria for SIRS were enrolled. Daily concentrations of PCT, C-reactive protein (CRP) and white cell count (WCC) were measured over three days. The diagnostic and predictive performance of these biomarkers were assessed using area under the curve of the ROC. Results: In this study, medical and surgical cohorts had similar PCT concentrations. Peak (p=0.02) and daily PCT (p<0.001) concentrations were significantly higher in patients with sepsis compared to SIRS. There were no significant differences in the CRP and WCC concentrations between the two groups. Peak PCT was significantly higher in patients with bacteraemia than those without (49.1 [19.3- 57] vs. 6.9 [1.1-25.6 ng/ml], p=0.001). PCT was diagnostic of sepsis and bacteraemia (AUC of 0.73 [0.64-0.83] and 0.80 [0.66-0.93] respectively). Peak PCT was significantly higher in septic patients with culture positive compared to culture negative (p=0.02). At the optimal cut-point of 10.68 ng/ml for peak PCT, sepsis was very likely with specificity of 86% and psotive predictive value (PPV) of 91%. There was a good correlation between PCT concentration and the Sequential Organ Failure Assessment (SOFA) score in the sepsis cohort (r=0.62, p<0.0001). Conclusion: PCT was better than CRP or WCC in differentiating sepsis from non-infectious SIRS in critically-ill patients. PCT is diagnostic of sepsis and bacteraemia, and is also useful as an indicator of severity of organ failure in sepsis.
format	Article
author	Mat Nor, Mohd Basri Md Ralib, Azrina Mohamed, Abdul Hadi Abdullah, Nor Zamzila
author_facet	Mat Nor, Mohd Basri Md Ralib, Azrina Mohamed, Abdul Hadi Abdullah, Nor Zamzila
author_sort	Mat Nor, Mohd Basri
title	Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia
title_short	Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia
title_full	Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia
title_fullStr	Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia
title_full_unstemmed	Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia
title_sort	procalcitonin as a sepsis marker: experience of an intensive care setting in malaysia
publisher	Ministry of Health and Universiti Brunei Darussalem
publishDate	2013
url	http://irep.iium.edu.my/32164/ http://irep.iium.edu.my/32164/ http://irep.iium.edu.my/32164/1/BIMJ201394243.pdf
first_indexed	2023-09-18T20:46:25Z
last_indexed	2023-09-18T20:46:25Z
_version_	1777409705355771904

Procalcitonin as a sepsis marker: experience of an intensive care setting in Malaysia

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