Role of decisive markers in diagnosis and outcome of patients with septic shock

Full text

Introduction

Of the few biochemical parameters available to monitor critically ill patients and to control the course of therapy in severe inflammation, procalcitonin (PCT) and polymorphonuclear (PMN) elastase enzyme stand as innovative diagnostic parameters with features different from other presently routine indicators of the inflammatory response.

Methods

Our work aims at assessing the potential role of PCT and PMN elastase enzyme in early diagnosis and early prediction of prognosis in patients (pts) with sepsis and septic shock. To achieve this goal we studied 20 pts with septic shock (16 male and 4 female, mean age 50.15 years), together with a second group comprising 10 pts (9 male, mean age 49.2 years) with systemic sepsis without shock. A third group including 20 healthy volunteers matching with age and sex, served as controls. Serum PCT and PMN elastase enzyme levels were estimated on admission for both pts and control groups with other laboratory investigations and clinical parameters. A multivariate, discriminate analysis was performed using the following variables: PCT, PMN elastase enzyme, albumin, α-1-antitrypsin, α-2-macroglobulin, and C-reactive protein (CRP), as independent parameters.

Results

Comparing the three groups (septic shock, sepsis, and healthy control subjects) all together our results exhibited significantly higher PCT levels (59.7 ± 14, 97.2 ± 14 vs 0.4 ± 0.1 ng/ml, P<0.0000), higher PMN elastase enzyme (183.4 ± 101, 132.1 ± 117 vs 6.5 ± 3 μg/l, P<0.0000), lower serum albumin (2.1 ± 0.6, 2.6 ± 0.9 vs 4.7 ± 0.5 gm%, P<0.05), higher α-1-antitrypsin (3.9 ± 1, 6.2 ± 3 vs 3.6 ± 0.6 mg/L, P<0.0001), higher α-2-macro-globulin (2.27 ± 0.8, 2.4± 1 vs 0.7± 0.2 mg/l, P<0.0000), higher CRP (52.2 ± 36, 46.8 ± 31 vs 5.4 ± 0.4 mg/l, P<0.0000).

With further patient subdivision to 6 survivors and 24 non-survivors only PCT could be identified as independent predictor for short term prognosis in patients with sepsis with an overall predictive accuracy 80% and with cut off value of ≥ 78 ng/ml. While PMN elastase enzyme could be used as a parameter inside a model including the whole previous parameters with overall predictive accuracy 76.7%, and with cut off value of ≥ 142 μg/l.

Conclusion

Serum PCT and PMN elastase enzyme are independent useful diagnostic markers for early detection of systemic inflammatory response syndrome with or without shock. However PCT has the advantage over the above mentioned parameters in being significantly predictive of short-term prognosis, with overall predictive accuracy of 80%. Procalcitonin, PMN elastase enzyme, α-1-antitrypsin, α-2-macroglobulin, CRP, and albumin, is a model which could be used for early prediction of complications of sepsis patients with overall predictive accuracy of 76.7%.