Procalcitonin (PCT) for monitoring ICU patients with severe polytrauma and early SIRS: results of a prospective study
© Current Science Ltd 1998
Published: 1 March 1998
PCT has been described by a number of authors for its use in monitoring severely ill patients. An increase of serum PCT concentration is usually found in a systemic response of the organism eg in severe sepsis or septic shock. Yet the exact patho-physiological mechanisms or possible function of PCT remain unclear. In this open prospective study we used PCT for the monitoring of intensive care unit (ICU) patients with severe polytrauma and early systemic inflammatory response syndrome (SIRS) in clinical routine.
PCT was measured using a commercial immunoluminometric assay (LUMItest ProCT by BRAHMS Diagnostica GmbH, Berlin, Germany). The assay was adapted to a Liamat system (Byk Sangtec). All 26 patients had a mean ISS (Injury Severity Score) of >50 and fulfilled the criteria for SIRS (systemic inflammatory response syndrome). There were 4 patients with septic episodes and 4 patients with manifestation of an ARDS. In addition, IL6 and CRP levels were measured. Blood samples for laboratory analysis were taken daily.
If not indicated otherwise numbers are given as median (25th–75th percentile). We did 145 PCT measurements in 26 patients which we observed for an average of 14 days after admission. Overall we found a PCT of 0.5 μg/l (0.2–2.6 μg/l). Evaluating the data of patient without sepsis, we found the highest PCT values in patients with severe SIRS and at least 2 major organ systems involved, especially when severe pelvic trauma was sustained. A Kruskal Wallis analysis revealed significant differences in the median PCT concentrations in these 3 groups. SIRS only: 0.2 μg/l (0.1–0.55 μg/l), severe SIRS: 5.8 μg/l (1.4–34.2 μg/l), Sepsis: 0.5 μg/l (0.3–3.5 μg/l).
Aim of our study was to investigate the value of PCT in monitoring of critically ill trauma patients in an evidence based procedure. We confirmed the data of other authors regarding the PCT levels in SIRS. However, we found that patients with major trauma especially the combination of pelvic and chest trauma developed PCT levels that in previous studies were found in severe bacterial sepsis only.