C-reactive protein and procalcitonin in septic and HIV infection patients

Introduction

Sepsis is an answer from the host to infection characterized by some clinical and laboratory signs. They are neither specific nor sensitive for some infection cases, mainly in immuno-suppression patients. The identification of laboratory variables for these patients could therefore be diagnosed faster. This study evaluated the role for C-reactive protein (CRP) and procalcitonin (PCT) as such diagnostic variables from sepsis in HIV/AIDS infection patients compared with non-HIV infection patients.

Methods

A prospective study, during 1 year in the ICU of a quaternary hospital. Septic patients were identified according to the SCCM/ACCP 1992 consensus. The patients were separated into two groups: sepsis and HIV/AIDS infection (Group 1), and sepsis without HIV infection (Group 2). CPR and PCT values were determined for all patients. Patients who stayed less than 24 hours in the ICU, with liver failure, with chronic renal failure needing replacement, immediately postoperative and other cases from immunosuppression were excluded from the study.

Results

Overall 44 patients were enrolled in the study, 22 in each group, the median age was 42 (35 to 55) years and 56.8% were male. The ICU mortality rate was 36.4%. The median APACHE II and SOFA scores at admission were, respectively, 21.5 (16 to 27) and 8.5 (5 to 10). There were no demographic and physiologic differences between both groups. While the patients from Group 1 presented lower values of CRP (159 (69 to 180) mg/dl) at the beginning of the treatment than patients from Group 2 (168 (129 to 270) mg/dl, P = 0.028), the same was found in relation to the PCT values (0.87 (0.33 to 4.19) ng/ml in Group 1 vs 2.35 (1.03 to 5.30) ng/ml in Group 2, P = 0.03). In addition, the leukocyte values were lower in Group 1 (7,205 (3,220 to 9,050) cells/mm³) than Group 2 (19,630 (13,140 to 25,950) cells/mm³, P < 0.001). When evaluated, however, only in Group 1 was a higher value of CRP (160 (90 to 185) mg/dl) found in the nonsurviving patients than in surviving patients (95 (10 to 160) mg/dl, P = 0.008). On other hand, the same was noted with PCT values; the Group 1 nonsurviving patients presented 2.1 (0.55 to 6.2) ng/ml versus 0.65 (0.27 to 2.8) ng/ml in surviving patients, P = 0.036.

Conclusion

Septic patients with HIV/AIDS presented lower values of CRP and PCT than septic patients without HIV infection. However, the higher values of CRP and PCT in septic patients with HIV/AIDS infection determined the higher mortality rate.