Login Register Cart 0
Generic placeholder image

Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Procalcitonin and qSOFA as a Marker of Mortality in Sepsis.

Author(s): Ashaq Hussain Parrey*, Manzoor Koka, Basharat Kassana and Mohd Ismail

Volume 19, Issue 3, 2024

Published on: 03 April, 2024

Page: [196 - 203] Pages: 8

DOI: 10.2174/0115748871288534240322083746

Price: $65

Abstract

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The qSOFA and procalcitonin are currently used for both diagnostic as well as prognostic purposes.

Objective: To explore the combined use of day one procalcitonin level and qSOFA scores for prognostication of sepsis-related mortality.

Design: This was a prospective observational study.

Participants: All patients who fulfilled the inclusion criteria for sepsis with an age of more than 16 years were enrolled in the study.

Results: In this study of 211 patients, 15 patients died (7.1%) during hospital stay. Among the 15 patients who died, the highest mortality of 29.4% was seen in patients with qSOFA of “3”, qSOFA of “2” had a mortality of 12.8%, qSOFA of “1” had a mortality of 1% and qSOFA of “0” had zero mortality. In this study, procalcitonin had a statistically significant positive correlation/association with both qSOFA and mortality.

Conclusion: The qSOFA and procalcitonin at presentation to the emergency department in septic patients have a significant correlation with mortality in patients hospitalized with sepsis. Obtaining these two parameters at presentation will help in managing aggressively these patients who at presentation have higher qSOFA and procalcitonin levels.

Keywords: Sepsis, qSOFA, procalcitonin, mortality, PCT, CRP.

« Previous Next »
[1]
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315(8): 801-10.
[http://dx.doi.org/10.1001/jama.2016.0287] [PMID: 26903338]
[2]
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47(11): 1181-247.
[http://dx.doi.org/10.1007/s00134-021-06506-y] [PMID: 34599691]
[3]
Sazonov V, Abylkassov R, Tobylbayeva Z, Saparov A, Mironova O, Poddighe D. Case Series: Efficacy and safety of hemoadsorption With HA-330 adsorber in septic pediatric patients with cancer. Front Pediatr 2021; 9: 672260.
[http://dx.doi.org/10.3389/fped.2021.672260] [PMID: 34178889]
[4]
Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: Analysis for the Global Burden of Disease Study. Lancet 2020; 395(10219): 200-11.
[http://dx.doi.org/10.1016/S0140-6736(19)32989-7] [PMID: 31954465]
[5]
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: A systematic review. Lancet Respir Med 2018; 6(3): 223-30.
[http://dx.doi.org/10.1016/S2213-2600(18)30063-8] [PMID: 29508706]
[6]
Salluh JIF, Soares M, Singer M. Spreading the knowledge on the epidemiology of sepsis. Lancet Infect Dis 2017; 17(11): 1104-6.
[http://dx.doi.org/10.1016/S1473-3099(17)30480-2] [PMID: 28826589]
[7]
Reinhart K, Daniels R, Kissoon N, Machado FR, Schachter RD, Finfer S. Recognizing sepsis as a global health priority - A WHO resolution. N Engl J Med 2017; 377(5): 414-7.
[http://dx.doi.org/10.1056/NEJMp1707170] [PMID: 28658587]
[8]
Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence 2014; 5(1): 4-11.
[http://dx.doi.org/10.4161/viru.27372] [PMID: 24335434]
[9]
Xie J, Wang H, Kang Y, et al. The epidemiology of sepsis in Chinese ICUs: A national cross-sectional survey. Crit Care Med 2020; 48(3): e209-18.
[http://dx.doi.org/10.1097/CCM.0000000000004155] [PMID: 31804299]
[10]
Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021; 49(11): e1063-143.
[http://dx.doi.org/10.1097/CCM.0000000000005337] [PMID: 34605781]
[11]
Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: Results from the Surviving Sepsis Campaign database. Crit Care Med 2015; 43(3): 567-73.
[http://dx.doi.org/10.1097/CCM.0000000000000742] [PMID: 25479113]
[12]
Tang Y, Choi J, Kim D, et al. Clinical predictors of adverse outcome in severe sepsis patients with lactate 2–4 mM admitted to the hospital. QJM 2015; 108(4): 279-87.
[http://dx.doi.org/10.1093/qjmed/hcu186] [PMID: 25193540]
[13]
Haas SA, Lange T, Saugel B, et al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med 2016; 42(2): 202-10.
[http://dx.doi.org/10.1007/s00134-015-4127-0] [PMID: 26556617]
[14]
Knaus WA, Sun X, Nystrom PO, Wagner DP. Evaluation of definitions for sepsis. Chest 1992; 101(6): 1656-62.
[http://dx.doi.org/10.1378/chest.101.6.1656] [PMID: 1600787]
[15]
Peres Bota D, Lopes Ferreira F, Mélot C, Vincent JL. Body temperature alterations in the critically ill. Intensive Care Med 2004; 30(5): 811-6.
[http://dx.doi.org/10.1007/s00134-004-2166-z] [PMID: 15127194]
[16]
Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia. Am J Med 1980; 68(3): 344-55.
[http://dx.doi.org/10.1016/0002-9343(80)90102-3] [PMID: 6987871]
[17]
Haase N, Ostrowski SR, Wetterslev J, et al. Thromboelastography in patients with severe sepsis: A prospective cohort study. Intensive Care Med 2015; 41(1): 77-85.
[http://dx.doi.org/10.1007/s00134-014-3552-9] [PMID: 25413378]
[18]
Neyra JA, Canepa-Escaro F, Li X, et al. Association of hyperchloremia with hospital mortality in critically ill septic patients. Crit Care Med 2015; 43(9): 1938-44.
[http://dx.doi.org/10.1097/CCM.0000000000001161] [PMID: 26154934]
[19]
Thiery-Antier N, Binquet C, Vinault S, Meziani F, Boisramé-Helms J, Quenot JP. Is thrombocytopenia an early prognostic marker in septic shock? Crit Care Med 2016; 44(4): 764-72.
[http://dx.doi.org/10.1097/CCM.0000000000001520] [PMID: 26670473]
[20]
van Vught LA, Wiewel MA, Klein Klouwenberg PMC, et al. Admission Hyperglycemia in critically ill sepsis patients: Association with outcome and host response. Crit Care Med 2016; 44(7): 1338-46.
[http://dx.doi.org/10.1097/CCM.0000000000001650] [PMID: 26958752]
[21]
Schuetz P, Birkhahn R, Sherwin R, et al. Serial Procalcitonin predicts mortality in severe sepsis patients: Results from the multicenter procalcitonin monitoring sepsis (MOSES) study. Crit Care Med 2017; 45(5): 781-9.
[http://dx.doi.org/10.1097/CCM.0000000000002321] [PMID: 28257335]
[22]
Maruna P, Nedelníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res 2000; 49(1): 57.
[23]
Shiferaw B, Bekele E, Kumar K, Boutin A, Frieri M. The role of procalcitonin as a biomarker in sepsis. J Infect Dis Epidemiol 2016; 2: 006.
[24]
Becker KL, Nylén ES, White JC, Müller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: A journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004; 89(4): 1512-25.
[http://dx.doi.org/10.1210/jc.2002-021444] [PMID: 15070906]
[25]
Christ-Carin M, Müller B. Procalcitonin in bacterial infections - hype, hope, more or less? Swiss Med Wkly 2005; 135(31-32): 451-60.
[http://dx.doi.org/10.4414/smw.2005.11169] [PMID: 16208582]
[26]
Gilbert DN. Use of plasma procalcitonin levels as an adjunct to clinical microbiology. J Clin Microbiol 2010; 48(7): 2325-9.
[http://dx.doi.org/10.1128/JCM.00655-10] [PMID: 20421436]
[27]
Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: A systematic review and meta-analysis. Crit Care Med 2006; 34(7): 1996-2003.
[http://dx.doi.org/10.1097/01.CCM.0000226413.54364.36] [PMID: 16715031]
[28]
Karzai W, Oberhoffer M, Meier-Hellmann A, Reinhart K. Procalcitonin — A new indicator of the systemic response to severe infections. Infection 1997; 25(6): 329-34.
[http://dx.doi.org/10.1007/BF01740811] [PMID: 9427049]
[29]
Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): A multicentre randomised controlled trial. Lancet 2010; 375(9713): 463-74.
[http://dx.doi.org/10.1016/S0140-6736(09)61879-1] [PMID: 20097417]
[30]
Giamarellos-Bourboulis EJ, Mega A, Grecka P, et al. Procalcitonin: A marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient? Intensive Care Med 2002; 28(9): 1351-6.
[http://dx.doi.org/10.1007/s00134-002-1398-z] [PMID: 12209289]
[31]
Nylen ES, Whang KT, Snider RH Jr, Steinwald PM, White JC, Becker KL. Mortality is increased by procalcitonin and decreased by an antiserum reactive to procalcitonin in experimental sepsis. Crit Care Med 1998; 26(6): 1001-6.
[http://dx.doi.org/10.1097/00003246-199806000-00015] [PMID: 9635646]
[32]
Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: Clinical utility and limitations. Crit Care Med 2008; 36(3): 941-52.
[http://dx.doi.org/10.1097/CCM.0B013E318165BABB] [PMID: 18431284]
[33]
Gilbert DN. Role of procalcitonin in the management of infected patients in the intensive care unit. Infect Dis Clin North Am 2017; 31(3): 435-53.
[http://dx.doi.org/10.1016/j.idc.2017.05.003] [PMID: 28779830]
[34]
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis. JAMA 2016; 315(8): 762-74.
[http://dx.doi.org/10.1001/jama.2016.0288] [PMID: 26903335]
[35]
Shankar-Hari M, Phillips GS, Levy ML, et al. Sepsis definitions task force. JAMA 2016; 315(8): 775-87.
[36]
Freund Y, Lemachatti N, Krastinova E, et al. Medline ® abstracts for references 37-43 of 'sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. JAMA 2017; 317(3): 301.
[37]
Raith EP, Udy AA, Bailey M, et al. Australian and New Zealand intensive care society (ANZICS) centre for outcomes and resource evaluation (CORE). JAMA 2017; 317(3): 290.
[38]
Gilbert DN. Procalcitonin as a biomarker in respiratory tract infection. Clin Infect Dis 2011; 52 (Suppl. 4): S346-50.
[http://dx.doi.org/10.1093/cid/cir050] [PMID: 21460294]
[39]
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348(16): 1546-54.
[http://dx.doi.org/10.1056/NEJMoa022139] [PMID: 12700374]
[40]
Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014; 311(13): 1308-16.
[http://dx.doi.org/10.1001/jama.2014.2637] [PMID: 24638143]
[41]
Li A, Ling L, Qin H, et al. Epidemiology, Management, and outcomes of sepsis in ICUs among countries of differing national wealth across Asia. Am J Respir Crit Care Med 2022; 206(9): 1107-16.
[http://dx.doi.org/10.1164/rccm.202112-2743OC] [PMID: 35763381]
[42]
Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med 2015; 372(17): 1629-38.
[http://dx.doi.org/10.1056/NEJMoa1415236] [PMID: 25776936]
[43]
Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med 2003; 31(6): 1737-41.
[http://dx.doi.org/10.1097/01.CCM.0000063440.19188.ED] [PMID: 12794413]
[44]
Nargis W, Ibrahim M, Ahamed B. Procalcitonin versus C-reactive protein: Usefulness as biomarker of sepsis in ICU patient. Int J Crit Illn Inj Sci 2014; 4(3): 195-9.
[http://dx.doi.org/10.4103/2229-5151.141356] [PMID: 25337480]
[45]
Meidani M, Khorvash F, Abolghasemi H, Jamali B. Procalcitonin and quantitative C-reactive protein role in the early diagnosis of sepsis in patients with febrile neutropenia. South Asian J Cancer 2013; 2(4): 216-9.
[http://dx.doi.org/10.4103/2278-330X.119913] [PMID: 24455636]
[46]
Fioretto JR, Martin JG, Kurokawa CS, et al. Comparison between procalcitonin and C-reactive protein for early diagnosis of children with sepsis or septic shock. Inflamm Res 2010; 59(8): 581-6.
[http://dx.doi.org/10.1007/s00011-010-0161-0] [PMID: 20131075]
[47]
Jain S, Sinha S, Sharma SK, et al. Procalcitonin as a prognostic marker for sepsis: A prospective observational study. BMC Res Notes 2014; 7(1): 458.
[http://dx.doi.org/10.1186/1756-0500-7-458] [PMID: 25034373]
[48]
Meng FS, Su L, Tang YQ, Wen Q, Liu YS, Liu ZF. Serum procalcitonin at the time of admission to the ICU as a predictor of short-term mortality. Clin Biochem 2009; 42(10-11): 1025-31.
[http://dx.doi.org/10.1016/j.clinbiochem.2009.03.012] [PMID: 19324026]
[49]
Clec’h C, Fosse J-P, Karoubi P, et al. Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med 2006; 34(1): 102-7.
[PMID: 16374163]
[50]
Hur M, Kim H, Lee S, et al. Diagnostic and prognostic utilities of multimarkers approach using procalcitonin, B-type natriuretic peptide, and neutrophil gelatinase-associated lipocalin in critically ill patients with suspected sepsis. BMC Infect Dis 2014; 14: 224.
[PMID: 24761764]
[51]
Askim A, Moser F, Gustad LT, Stene H, Gundersen M, Asvold BO. Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality—a prospective study of patients admitted with infection to the emergency department. Scand J Trauma Resusc Emerg Med 2017; 25(1): 56.
[52]
Simpson SQ, City K. New sepsis criteria: A change we should not make. Chest 2016; 149(5): 1117-8.
[53]
Sprung CL, Schein RMH, Balk RA. The new sepsis consensus definitions: The good, the bad and the ugly. Intens Care Med 2016; 42(12): 2024-6.
[54]
Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013; 41(2): 580-637.
[http://dx.doi.org/10.1097/CCM.0b013e31827e83a] [PMID: 23353941]
[55]
Baig MA, Sheikh S, Hussain E, et al. Comparison of qSOFA and SOFA score for predicting mortality in severe sepsis and septic shock patients in the emergency department of a low middle income country. Turk J Emerg Med 2018; 18(4): 148-51.
[http://dx.doi.org/10.1016/j.tjem.2018.08.002] [PMID: 30533557]
[56]
Abdullah SMOB, Grand J, Sijapati A, Puri PR, Nielsen FE. qSOFA is a useful prognostic factor for 30-day mortality in infected patients fulfilling the SIRS criteria for sepsis. Am J Emerg Med 2020; 38(3): 512-6.
[http://dx.doi.org/10.1016/j.ajem.2019.05.037] [PMID: 31171438]
[57]
Shahsavarinia K, Moharramzadeh P, Arvanagi RJ, Mahmoodpoor A. qSOFA score for prediction of sepsis outcome in emergency department. Pak J Med Sci 2020; 36(4): 668-72.
[http://dx.doi.org/10.12669/pjms.36.4.2031] [PMID: 32494253]
[58]
Alkholi UM, Abd Al-Monem N, Abd El-Azim AA, Sultan MH. Serum procalcitonin in viral and bacterial meningitis. J Glob Infect Dis 2011; 3(1): 14-8.
[http://dx.doi.org/10.4103/0974-777X.77290] [PMID: 21572603]
[59]
Standage SW, Wong HR. Biomarkers for pediatric sepsis and septic shock. Expert Rev Anti Infect Ther 2011; 9(1): 71-9.
[http://dx.doi.org/10.1586/eri.10.154] [PMID: 21171879]
[60]
Schlattmann P, Wacker C. Procalcitonin as a diagnostic marker for sepsis: A systematic review and meta-analysis. Lancet Infect Dis 2013; 13(5): 426-35.
[61]
Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: A randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 2007; 131(1): 9-19.
[http://dx.doi.org/10.1378/chest.06-1500] [PMID: 17218551]

Rights & Permissions Print Cite
Article Metrics
13
1
Wayfinder Image
© 2024 Bentham Science Publishers | Privacy Policy