Secretory phospholipase A2 (sPLA2), procalcitonin (PCT) and C-reactive protein (CRP) for the diagnosis and differentiation of septic shock and non-septic shock

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Introduction

Serum sPLA2 and CRP levels increase in patients with systemic inflammatory response syndrome (SIRS). High serum levels of PCT have been detected in patients with inflammatory conditions from invasive bacterial and fungal infections. The aim of this study was to determine the diagnostic value of sPLA2, CRP and PCT in septic shock.

Patients and methods

Consecutive patients admitted to the ICU with shock were included. Patients were screened in two groups: septic shock (American college of chest physicians criteria) and non-septic shock. Upon admission, serum sPLA2, CRP and PCT were simultaneously analysed. Data, expressed as means ± SD, were analysed by an independent investigator not involved in ICU. The catalytic activity of sPLA2 was detected by fluorimetric assays (normal 10 mU/ml). PCT was analysed by commercially available Lumitest^® kit (BRAHMS, Berlin).

Results

Fifty-nine patients were included (20 women, 39 men), thirty-nine with septic shock (13 women, 26 men, mean age=56± 18) and twenty with non-septic shock (7 women, 13 men, mean age=51± 22). Total mortality=40%. Septic shock mortality=51% and non-septic shock mortality=20%.

sPLA2, CRP and PCT values were significantly higher in patients with septic shock. The areas under the curve (ROC) of sPLA2, CRP and PCT were respectively 0.896, 0.792 and 0.765. The area under the curve of sPLA2 was significantly higher than PCT area (P<0.05).

Figure

Conclusion

PCT does not appear to be a better marker to discriminate septic shock and non-septic shock than sPLA2 and CRP.

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