Abstract
Abstract
Introduction: Sepsis is a common, life-threatening condition characterized by organ dysfunction due to an inappropriate host response to infection. The aim of this study is to compare the contribution of procalcitonin (PCT) and C-Reactive Protein (CRP) in the diagnosis and monitoring of sepsis in a medical-surgical intensive care unit.
Methods: This is a retrospective study conducted in 2022, including all patients over 18 years old admitted to the intensive care unit with sepsis.
Results: 110 patients were included, with a mean age of 56 ± 19.6 years. Initial levels of PCT and CRP were correlated (p=0.005), but their peaks were not associated with treatment failure or 30-day mortality. Variations in PCT and CRP levels after five to seven days were correlated with treatment failure and mortality. In cases of successful antibiotic therapy, the median minimum PCT level was 0.33 ng/ml compared to 6.3 ng/ml in cases of failure (p=0.035), and the median minimum CRP level was 67 mg/L compared to 162.6 mg/L(p<0.001). Regarding 30-day mortality, the median minimum PCT level was 0.55 ng/ml in survivors compared to 3.6 ng/ml in deceased patients (p=0.02), and the median minimum CRP level was 63.8 mg/L in survivors compared to 141 mg/L in deceased patients (p<0.001).
Conclusion: Both PCT and CRP are effective for monitoring sepsis. However, due to its low cost , CRP is the most commonly used test.
References
Références
Font MD, Thyagarajan B, Khanna AK. Sepsis and Septic Shock - Basics of diagnosis, pathophysiology and clinical decision making. Med Clin North Am. 2020; 104 :573‑85.
Nannan Panday RS, Lammers EMJ, Alam N, Nanayakkara PWB. An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial. Crit Care Lond Engl. 2019; 23:182.
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021; 47 :1181‑247.
Pierrakos C, Velissaris D, Bisdorff M, Marshall JC, Vincent JL. Biomarkers of sepsis: time for a reappraisal. Crit Care Lond Engl. 2020; 24:287.
Malik M, Sreekantan Nair A, Illango J, Siddiqui N, Gor R, Fernando RW, et al. The Advancement in Detecting Sepsis and Its Outcome: Usefulness of Procalcitonin in Diagnosing Sepsis and Predicting Fatal Outcomes in Patients Admitted to Intensive Care Unit. Cureus.2021 ;13(4): e14439
Reinhart K, Meisner M. Biomarkers in the critically ill patient: procalcitonin. Crit Care Clin. 2011; 27 :253‑63.
Paudel R, Dogra P, Montgomery-Yates AA, Coz Yataco A. Procalcitonin: A promising tool or just another overhyped test? Int J Med Sci. 2020; 17 :332‑7.
Mierzchała-Pasierb M, Lipińska-Gediga M. Sepsis diagnosis and monitoring - procalcitonin as standard, but what next? Anaesthesiol Intensive Ther. 2019; 51 :299‑305.
Plebani M. Why C-reactive protein is one of the most requested tests in clinical laboratories? Clin Chem Lab Med. 2023; 61 :1540‑5.
Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F, et al. C-reactive protein and procalcitonin during course of sepsis and septic shock. Ir J Med Sci.2023;1‑12.
Castelli GP, Pognani C, Meisner M, Stuani A, Bellomi D, Sgarbi L. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care Lond Engl. 2004; 8: R234-242.
Oliveira CF, Botoni FA, Oliveira CRA, Silva CB, Pereira HA, Serufo JC, et al. Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med. 2013; 41 :2336‑43.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315 :801‑10.
Laura Evans, Andrew Rhodes, Waleed Alhazzani, Massimo Antonelli, Craig M Coopersmith, Craig French, et al. Crit Care Med. 2021. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.
Campion M, Scully G. Antibiotic Use in the Intensive Care Unit: Optimization and De-Escalation. J Intensive Care Med. 2018; 33 :647‑55.
Yentis SM, Soni N, Sheldon J. C-reactive protein as an indicator of resolution of sepsis in the intensive care unit. Intensive Care Med. 1995; 21 :602‑5.
Liang P, Yu F. Value of CRP, PCT, and NLR in Prediction of Severity and Prognosis of Patients with Bloodstream Infections and Sepsis. Front Surg. 2022; 9:857218.
Heyland DK, Johnson AP, Reynolds SC, Muscedere J. Procalcitonin for reduced antibiotic exposure in the critical care setting: a systematic review and an economic evaluation. Crit Care Med. 2011; 39:1792‑9.
Nargis W, Ibrahim M, Ahamed BU. Procalcitonin versus C-reactive protein: Usefulness as biomarker of sepsis in ICU patient. Int J Crit Illn Inj Sci. 2014; 4:195‑9.
Cui N, Zhang H, Chen Z, Yu Z. Prognostic significance of PCT and CRP evaluation for adult ICU patients with sepsis and septic shock: retrospective analysis of 59 cases. J Int Med Res. 2019 :1573‑9.
Ryu JA, Yang JH, Lee D, Park CM, Suh GY, Jeon K, et al. Clinical Usefulness of Procalcitonin and C-Reactive Protein as Outcome Predictors in Critically Ill Patients with Severe Sepsis and Septic Shock. PloS One. 2015; 10(9): e0138150.
Chen J, Tu X, Huang M, Xie Y, Lin Y, Hu J. Prognostic value of platelet combined with serum procalcitonin in patients with sepsis. Medicine (Baltimore).2023; 102.
Wang F, Pan W, Pan S, Wang S, Ge Q, Ge J. Usefulness of N-terminal pro-brain natriuretic peptide and C-reactive protein to predict ICU mortality in unselected medical ICU patients: a prospective, observational study. Crit Care Lond Engl. 2011; 15(1): R42.
Devran O, Karakurt Z, Adıgüzel N, Güngör G, Moçin OY, Balcı MK, et al. C-reactive protein as a predictor of mortality in patients affected with severe sepsis in intensive care unit. Multidiscip Respir Med. 2012 ;7(1) :47.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Imen Ghoufa, Asma Bachali, Sawssem Harrabi, Lamia Sghaier, Ikbel Ghachem, Mechaal Ben Ali, Sonia Chouaieb, Mohamed Yassine Kaabar