The Application Of Procalcitonin And Procalcitonin Clearance In Diagnosis And Prognostic Evaluation Of Sepsis

Objective: Procalcitonin(PCT) has been proposed as a specific biomarker of bacterial infectious and has been related to the severity of sepsis.To evaluate procalcitonin clearance(PCTc) as a prognostic biomarker in septic patient. By observing the PCT kinetics, analying the diagnosis and prognostic evaluation value of PCT and PCT-c in sepsis It is unclear that the action mechanism of PCT as an inflammation index in the process of sepsis. By observing the kinetics of PCT and other inflammatory in animal experiments, to discusses its mechanism. Methods: 1) This study included the sepsis patients in local comprehensive ICU from July 2012 to July 2014. All patients was detected the concentration of PCT, APACHE II and SOFA score. In the 8 am of 1, 3, 5, 7,9 days, serum PCT concentration was detected and PCT-c was calculate. According to the survival situation of 28 days, the patients was divided into survival group and death group, comparing the difference between two groups and evaluating the prognosis. 2)This is a prospective observational study, the VAP patients in ICU was included from February 2012 to June 2014. All the patients was given empirical anti-infection treatment immediately when the VAP was diagnosis. According to the clinical efficacy after 10 days, patients was divided into improved group and deteriorating group. When VAP was diagnosised, serum PCT level was detected in 1, 3, 5, 7, 9 days, and PCT-c was calculated to determined the value of PCT in judging the prognosis of VAP patients. 3)Serum PCT and other imflammatory factors was observed in different periods of septic rats, By intervening in one of the inflammatory factor to understanding the correlation of PCT and other inflammatory factor. Results: 1) Compared to PCT value in frist day and3 th day, there is no difference between the survival group and death group. After the fifth day the PCT values was significantly higher in death group than the survival group.PCT-c in death group were lower than group survival. The absolute value of PCT in 1st day is lower in judgment prognosis than scoring system such an APACHE II and SOFAscore. But PCT-c better. 2) A total of 128 patients with VAP admitted into intensive care unit were enrolled. The patients were divided into recovery group(n=88) and deterioration group(n=40). There was no significant difference in PCT level at 1 day after VAP was diagnosed between recovery group and deterioration group, With prolonged treatment, PCT was gradually decreased in recovery group, while remained at higher level in deterioration group, which was significantly lowered at 5 days after VAP diagnosed in recovery group compared with that in the deterioration group. PCTc maintained higher level in recovery group which was gradually increased with the improvement of the disease, and PCTc in deterioration group was lowered which was gradually decreased with the development of the disease. PCTc at 5, 7, 9 days in recovery group was significantly higher than that in deterioration group. By meta-analysis, PCT has value to infection judgment in solid organ transplant patients. 3) With the process of sepsis, PCT, IL-6 and IL-10 increased obviously, i NOS change trend was difference,intervention of i NOS did not affect PCT. Conclusion: 1) PCT has value in diagnos sepsis.The initial absolute peak of PCT in the inflammatory process induced by sepsis was not a good indicator to judge the prognosis of septic patients. Its potency is low than the commonly used evaluation criteria such as APACHE II or SOFA;PCT-c were significantly higher than those of PCT absolute value for judging the prognosis of patients with severe infection disease, can be used as a good index of judging prognosis.2) PCT and PCT-c can predict the prognosis of patients with VAP and PCT-c is better.PCT has certain value in diagnosis of bacterial infections in solid organ transplant recipients. 3) A significant rise in i NOS expression in the early sepsis, may be associated with sepsis early death. Intervention i NOS failed to reduce inflammation factors and the levels of PCT. IL-6, TNF alpha, PCT is an important index of evaluating prognosis of sepsis, it could also be the reason that is hard to change the prognosis of sepsis.