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Procalcitonin-A new biological marker for severe systemic bacterial infections in critically ill patients

Severe infection and sepsis are common causes of morbidity and mortality in intensive care units (ICU). Infections and sepsis are accompanied by clinical and laboratory signs such as changes in body temperature, altered white blood cell count, hypotension, tachycardia and positive blood culture. However, these signs and symptoms of systemic inflammation and sepsis may have an infectious or non-infectious origin. Patients with SIRS, severe sepsis, organ dysfunction or shock, are often difficult to distinguish from patients with similar clinical signs and laboratory findings without infection.PCT has been recently studied as a possible marker of sepsis with a superior sensitivity and specificity, comparing with the other markers (CRP, proinflammatory cytokines- IL-6, IL-8). Measurements of procalcitonin (PCT) concentration appeared to be a more accurate diagnostic parameter for ; 1. Early diagnosis of infection, or differentiating SIRS/sepsis/septic shock patients 2. Routine determination of PCT may improve the treatment, prevent the unnecessary use of antibiotics and predict the outcome 3. PCT is superior for the diagnosis and the follow-up of patients with sepsis, severe sepsis or septic shock 4. New markers have been proposed for the diagnosis of sepsis: PCT, CRP and cytokines (IL-1, IL-6, TNF) Conclusion. Early diagnosis of serious infection in critically ill patients is important to prevent further complications and high mortality. In many cases, history and physical examination with or without routine laboratory tests will be sufficient to diagnose sepsis. Sometimes it is difficultt to identify the presence or absence of infection. In these cases a new markers of sepsis may provide crucial information. For that reason Procalcitonin measurements may be helpful in differentiating between infectious or non-infectious causes in-patients admitted to ICU. PCT is a new and innovative parameter, which reacts with high sensitivity and specificity to generalized infection and sepsis. PCT correlates better than all the other existing parameters to the inflammatory activity of the immune system. PTC can be used to establish the diagnoses and to monitor severe bacterial infections or may help in assessing the severity of infection, the prognosis of disease, and the response to therapeutic approach.

Procalcitonin; severe infections; critically ill patients

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