Surrogate Marker of Sepsis
Sepsis is one of the commonest problems associated with the admission of critically ill patients, especially HIV/AIDS patients at the Critical Care Units of Hospitals. Diagnosis and prognosis of sepsis in the clinical setting is a challenge since there is no diagnostic tool for measuring the severity and course of sepsis. Therefore, this study was designed to assess the use of Procalcitonin as a surrogate marker of sepsis in a case-control study of both septic and non-septic HIV/AIDS and also for the determination of its cut-off threshold for sepsis. Using a hospital-based case–control study design, 100 HIV/AIDS patients comprising of 66 septic cases and 34 nonseptic were recruited from the Emergency Department of Komfo Anokye Teaching Hospital (KATH), Ghana. Sepsis was defined using the Systemic inflammatory response syndrome (SIRS) criteria. Serum Procalcitonin (PCT) and Creactive protein (CRP) levels were measured by standard ELISA principle. Prevalence of the overall sepsis, was assessed at 60. 5% among patients who were on Anti-retroviral therapy (ART), 66. 7% in females and 33. 3% in males. Viral suppression was 71% in septic patients. The overall mortality rate recorded was 89. 4%. ART however, did not confer protection from death, as 56. 5% of cases on ART died. Only 22. 7% of the septic patients produced positive blood cultures. PCT was significantly higher in septic patients than in non-septic patients (p=0. 000) and also higher in patients with positive blood cultures as compared with negative blood cultures (p=0. 001). PCT levels were significantly high in patients who died as compared to those who survived (p=0. 000). The AUC of PCT and CRP were 0. 968 and 0. 726 at cut-offs of 0. 496 ng/ml and 39. 281 mg/L respectively for diagnosing sepsis in HIV/AIDS patients. The study clearly shows that PCT is a better surrogate marker for diagnosing sepsis in people living with HIV/AIDS as compared to CRP.
Sepsis is an old disease in medicine which has been recognized since 1, 000 BC in several different forms and its detection and treatment has gained profound interest in researchers for about 3, 000 years. It is defined as the host’s immune response to injury and/or infectious stimuli in the presence of a known infection. Systemic inflammatory response Syndrome criteria has been employed in defining sepsis. Systemic inflammatory response Syndrome (SIRS) was diagnosed when a patient meets any two of the following criteria: fever or hypothermia (body temperature ≥ 38°C or 90/min), tachypnoea (respiration>20/min or PaCO212.
Journal of Clinical chemistry and Laboratory Medicne