| Objective:Sepsis and septic MODS is the main cause of mortality of ICU hospital patients. Our purpose is to study the further application of procalcitonin (PCT) in ICU, combining with other indicators widely used in many hospitals, which is expected to contribute to clear the value of the indicators in the early diagnosis of sepsis, severity assessment, prognosis and antibiotics guidance.Method:We studied the patients hospitalized in ICU of Qilu Hospital from August 2009 to January 2010, recording the indicators examined on the first day hospitalized in ICU and every other day, including PCT, CRP, WBC, PLT, APACHEⅡscore, SOFA score, Lac, etc. The situation of etiologic change and antibiotic use was observed, aiming at explore the relationships among etiology, antibiotics and monitoring indicators. Sepsis is diagnosis by the standard of SCCM Washington Conference. Procalcitonin (PCT) is detected by Semi-quantitative determination. CRP is detected by quantitative determination. Blood gas analysis is detected by blood gas analyzer GEM Premier 3000 produced by IL company of the USA.Results:1. All the monitoring indicators values examined on the first day hospitalized in ICU of sepsis group were higher than that of non-sepsis group. The results were as follows:sepsis group:PCT (6.09±5.29) ng/ml,CRP(115.03±71.07) mg/L,WBC13.64(11.13/19.53) X 109/L,Lac2.15(1.25/2.80) mmol/L,APACHEII (24.65±7.27),SOFA9.70±3.26), non-sepsis group:PCT 0.3 (0.3/0.3) ng/ml,CRP 37 (20.55/68.20) mg/L,WBC 9.49(7.80/11.35)×109/L,Lac 0.90(0.60/1.25) mmol/L,APACHEII 12.50(6.00/17.50),SOFA 4.50(2.00/5.50), P<0.05. General sepsis:PCT4.57±4.80 ng/ml,CRP96.85±64.88 mg/L,WBC (13.96±4.95) X 109/L,Lac1.30(1.10/2.30) mmol/L server sepsis:PCT6.75±6.02 ng/ml,CRP154.17±81.20 mg/L,WBC (16.58±5.67) X 109/L, Lac3.26±3.15 mmol/L MODS:PCT8.25±4.93 ng/ml,CRP106.52±59.05 mg/L,WBC (19.46±10.72) X 109/L,Lac5.45±4.48 mmol/L.2,PCT,Lac,APACHEⅡ,SOFA were better than other monitoring indicators in severity assessment as well as prognosis.3,PCT was a better diagnosis indicator of sepsis than SOFA,APACHEII,Lac,WBC,heart rate,CRP,NEU%,body temperature. The area under ROC curve (value,95%CI) of each indicators are as follows:PCT(0.884, 0.810-0.957),SOFA(0.861,0.783-0.940),APACHE II (0.831,0.744-0.919),Lac (0.808,0.715-0.901).4,PCT of antibiotic sensitive group (AS) was 0.3ng/ml, which was significant lower than that of antibiotic non-sensitive group (ANS) (7.642 ng/ml), and the difference between these two groups in PCT examination was more significant than that in other indicators.5,Traded by sensitive antibiotics, PCT of D5 is markedly lower than that of Dl.6,Groups based on PCT value were G1+2, G1, G2, G3+4, G3, G4, G5. The mortality of PCT continuously positive group (G3, G4) was higher than that of PCT negative group or PCT rapid converted to negative group (G1, G2). The patients with continuous higher PCT level (≥2ng/ml) had higher mortality rate than patients with lower PCT level (≥0.5ng/ml, and <2ng/ml), and the difference were statistically significant.7,Each indicator of the fifth day (D5) were analyzed by ROC curve with mortality for state variables, and the area under ROC curve of each indicator was as follows:SOFA 0.891, Lac 0.829, APACHEⅡ0.814, PCT 0.813. Comparing with area under ROC curve of other indicators, SOFA, Lac, APACHEII, PCT had significantly superior value for diagnosis of mortality of patients with sepsis.8,Etiology of D1:baumanii 24, Pseudomonas aeruginosa 12, Escherichia coli 9, Klebsiella pneumonia 8.9,Mortality at the 28th day: non-infection 2/24,local infection 8/24,general sepsis 5/17,severe infection 8/12,MODS 10/10.Conclusion:1,Serum procalcitonin is an effective indicator for early diagnosis of sepsis recently, which is better than other indicators on sepsis diagnosis and severity assessment. The higher the concentration of PCT, the more severe or out of effective control the infection was.2,PCT can be used to speculate whether the antibiotic treatment used on patient who got a definite diagnosis of infection was reasonable previously. Higher serum procalcitonin concentration often suggested that the infection had not been controlled or sensitive to antibiotics. PCT was negative, suggesting that the pathogen was sensitive to antibiotics, but it should be differentiated from non-bacterial infection.3,Procalcitonin can be used to guide the antibiotic application. Decreasing of procalcitonin level suggested effective antibiotic treatment, and infection gradually brought under control. On the contrary, the continuing drop or increasing of PCT prompted antibiotics is not sensitive or poor prognosis.4,Sepsis,severe sepsis and MODS are still the most important causes of mortality in ICU. it was significantly increased risk of death on severe sepsis stage of the development than on simple sepsis.5,ICU patients infected with Bacterial infections were the main pathogen of ICU patients, of which the largest proportion is Gram-negative bacteria. Mixed infections were common, and antibiotic resistance was high.
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