A study to evaluate the role of procalcitonin as a sepsis marker among elderly population

 

 

Abstract              Background: Sepsis is a systemic inflammatory response secondary to an acute infection. The incidence of sepsis and mortality due to it has increased, particularly in older adults above 60yrs of age and is one of the leading causes of mortality in them. More than 50% of the population with severe sepsis is over 65 yrs. old. Since there is a worldwide increase in aging population, the incidence of sepsis is also expected to raise. Objective: To estimate the significance of procalcitonin as a biomarker in the diagnosis of sepsis in elderly patients. Methodology: The present prospective study was done by the department of General Medicine at Gadag Institute of medical Sciences, Gadag from March 2020 to July 2021.A total of 50 study subjects aged more than 60 who were admitted in the hospital for sepsis and who met the inclusion criteria were included in the study. Results: There is a significant rise in serum procalcitonin based on the severity of sepsis, patients with septic shock showing a higher level of procalcitonin compared to those with severe sepsis. In our study serum procalcitonin was significantly raised in patients with severe sepsis and septic shock Increased serum procalcitonin was strongly related to mortality The relation between serum procalcitonin and mortality was statistically significant. Conclusion: Increased procalcitonin level at admission is a better predictor of organ dysfunction and mortality in elderly patients and its prognostic value in elderly patients is much better when compared to other markers of sepsis including CRP.

Keywords: Procalcitonin, Sepsis, Elderly, Serum Markers, Mortality

 

INTRODUCTION

Sepsis is a syndrome of biochemical, physiologic and pathologic abnormalities caused by dysregulated host response to infection leading to organ dysfunction. It is a life-threatening condition, that arises when the body’s response to an infection injures its own tissue and organs. It is of major public health interest. Sepsis is common in elderly, critically ill and immune compromised patients. Incidence of sepsis is increasing, likely due to increase in aging population with more co-morbidities. Sepsis is a leading cause of critical illness and mortality worldwide.^1,2 Septic shock is a subset of sepsis in which underlying circulating and cellular metabolism abnormalities are profound enough to substantially increase mortality. Patients with septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥ 65mm of Hg and having a serum lactate level > 2mmol/L despite adequate volume resuscitation.³ Sepsis and ARDS are more common in elderly and are the most common cause of ICU admission. The mortality from sepsis increases with age. The most common reason for older patients getting admitted to hospital is sepsis and is nearly fourfold more than the admission rate for acute coronary events. Pneumonia one of the major causes of mortality is the most common cause of infectious death and also the leading cause of severe sepsis and septic shock ⁴. With increasing age, the incidence of pneumonia increases and is related with increased morbidity, mortality and health care costs. In older adults the most frequently acquired bacterial infection is UTI and is one of the commonly diagnosed infection in elderly The early detection of patients with sepsis with poor prognosis or with an increased risk of mortality is very important in order to prevent subsequent organ dysfunction, which further increases the degree of complications and thereby mortality. Hence there is an obvious need for biomarkers of inflammation to detect bacterial infections in patients with sepsis.⁵ Procalcitonin levels tend to increase with organ dysfunction and increase in severity of sepsis, Furthermore, administration of procalcitonin to septic animals had shown to increase their mortality risk, thereby indicating a relationship between increased serum procalcitonin and death. The serum procalcitonin levels may aid in earlier identification and better stratification of septic patients with increased risk of death.^6,7

Objective: To estimate the significance of procalcitonin as a biomarker in the diagnosis of sepsis in elderly patients.

 

MATERIALS AND METHODS

The present prospective study was done by the department of General Medicine at Gadag Institute of medical Sciences, Gadag from January 2020 to December 2020. A total of 50 study subjects who met the inclusion criteria were included in the study.

Inclusion criteria: Patients above 60 years of age with a diagnosis of Sepsis and willing to consent for the study

Exclusion criteria: Patients above 60 yrs. of age not willing to consent for the study. Patients who underwent surgery or trauma during the previous 72 hrs. Patients with burns and acute pancreatitis.

Procedure: Patients fulfilling the inclusion criteria are enrolled. History including demographic characteristics (age and sex), co-morbidities and physical examination findings are recorded. Blood sample were drawn from patients within 24 hrs following admission for basic laboratory investigations including basic biochemistry, complete blood count, coagulation profile and other relevant investigations for sepsis including CRP and Procalcitonin, Microbiological cultures from the suspected sources of infection were also done on admission. Scoring for severity of illness like APACHE II and SOFA scoring were done on admission. The role of Procalcitonin in the diagnosis and prognosis of sepsis in elderly is assessed and compared with the other standard markers of sepsis based on mortality of the patients Measurement of Procalcitonin: Using a sterile syringe, 5ml of venous blood was drawn after sterile precautions on admission, the sample should be kept at room temperature for 2hrs and should be centrifuged for 10 min at 3000rpm. Until analysis, the supernatant has to be stored at -70 degree Celsius. Serum Procalcitonin was measured using chemiluminescence technique. The test has to be done on a fully auto chemiluminescence immune assay analyser.

 

RESULTS

A total of 50 study subjects were analyzed during the study period.

Table 1: Social Profile of the study Study subjects

In the present study majority of them were nearly 72% of them were between 60 to 70 years ,20% were between 70 to 80 years and 8 % were more than 80 years of age. Nearly 56% of them were male and 44% of them were female.

 

Table 2: Distribution of study subjects based on the severity of Sepsis

Out of the 75 subjects in our study, 29(58%) of them presented with severe sepsis and 31(62%) with septic shock.

 

Table 3: Association between Procalcitonin level and Severity of sepsis

There is a significant rise in serum procalcitonin based on the severity of sepsis, patients with septic shock showing a higher level of procalcitonin compared to those with severe sepsis

 

Table 4: Association between Procalcitonin level and Outcome of the condition

In our study serum procalcitonin was significantly raised in patients with severe sepsis and septic shock. Increased serum procalcitonin was strongly related to mortality. The relation between serum procalcitonin and mortality was statistically significant.

DISCUSSION

There are only few studies based on the usefulness of procalcitonin in elderly with sepsis. Our study evaluated the significance of procalcitonin as a biomarker of sepsis in hospitalised elderly and compared it with other conventional markers of sepsis. In our study mortality was seen in nearly 44 % of the study subjects which is consistent with study findings of Jain. et al.¹ Our study showed significant increase in serum procalcitonin in elderly patients with sepsis, proving its utility as a marker of sepsis, which is consistent with the previous study by Chivate. et al.⁸ In our study serum procalcitonin on admission was markedly elevated in non-survivors, showing correlation between serum procalcitonin and mortality. This is comparable with the previous studies by Meng et al.⁹ and Clec’h et al.,⁸ whereas some studies didn’t find procalcitonin to predict mortality. The variation may be due to the fact that our study was conducted in an exclusively medical setup excluding surgical and trauma cases which are believed to show spurious rise in procalcitonin level, also majority of the organisms isolated in our study were gram negative. A gram-negative septicaemia is believed to have significant correlation with serum procalcitonin levels.^10,11 Several studies have shown the significance of procalcitonin in predicting prognosis in sepsis patients.^12,13 In our study serum procalcitonin level tends to rise with severity of sepsis and organ dysfunction which is consistent with the findings reported by Giamarellos-Baorboulis et al.¹³

 

CONCLUSION

Procalcitonin is significantly raised in non-survivors when compared to survivors. Procalcitonin test, as a biomarker of sepsis has greater value in detecting patients with sepsis. It’s of greater significance also in elderly population with sepsis but test results should always be interpreted in conjunction with clinical findings. Increased procalcitonin level at admission is a better predictor of organ dysfunction and mortality in elderly patients and its prognostic value in elderly patients is much better when compared to other markers of sepsis including CRP.

 

REFERENCES

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