Role of Serial change in Serum Procalcitonin Levels as a Marker to Predict 28th Day Mortality in Patients with Sepsis and Septic Shock

Abstract

Objectives Worldwide, the estimated incidence of sepsis is >30 million cases every year with approximately 6 million deaths annually. Studies have shown that procalcitonin can be a reliable marker for diagnosis and predicting mortality in sepsis patients. In this study, we have tried to determine the role of serial changes in procalcitonin levels in predicting 28th day mortality in patients with sepsis and septic shock. Methods A prospective observational study was conducted at ABVIMS and Dr RML Hospital from 1st November 2017 to 31st March 2019. Adults who were diagnosed with sepsis or septic shock and admitted to ICU, emergency or ward of the hospital were included. Sample for procalcitonin was taken at admission (day-1), and on day-5. Patients were followed telephonically to record final outcome at 28 days. Results Fifty-seven patients were enrolled in the study. 35(61.4%) patients had sepsis and 22 (38.6%) were in septic shock. 10 (17.54%) patients died over a period of 28 days follow up. The level of serum procalcitonin on day-1 was significantly higher in non survivors as compared to survivors (7.66±2.07 vs. 5.78±2.48, p-value-0.029). Percentage change in procalcitonin (ΔPCT) from day 1 to day 5 was significantly low among non survivors as compared to survivors (29.94 ± 38.29 vs 70.33±34.56, p- value-0.006). Of 10 patient who died, 8(32%) had ≤80% decrease in (ΔPCT) and only 2 (6.25%) had >80%decrease in (ΔPCT) (p= 0.016). SOFA, q-SOFA and serum lactate were significantly higher among non survivors and were also significant in predicting mortality on univariate analysis. But multivariate analysis showed that only (ΔPCT) had significant correlation with mortality (OR: 0.972, p=0.022) and hence can hence can be used as an independent marker of mortality in sepsis patient. Conclusion This study determined that more than baseline values of procalcitonin, the change in serial procalcitonin (ΔPCT) was significant in predicting mortality in patients with sepsis and septic shock.