The Clinical Significance Of Dynamic Monitoring Of Procalcitonin For ICU Patients With Sepsis

Objective: To investigate the value of early diagnosis, distinguish severity, identify microbial infection and assess prognosis that the dynamic monitor of PCT for ICU patients with sepsis.Methods: Choosed 29 cases of SIRS patients and 166 cases of septic patients, defined as group A and group B respectively. Wherein group B was divided into sepsis group, severe sepsis group and septic shock group according to the severity of disease. Group B was divided into G+group, G-group, fungal group, mixed group and uncultured group according to the results of microbial culture. Group B was divided into survival group and nonsurvival group based on the 28-day mortality admitted to ICU. All patients extracted venous blood immediately after ICU admission(day 1) to test PCT and hs-CRP, therein 166 cases of septic patients extracted venous blood early in the morning on an empty stomach on the third day to the ICU to PCT motion detection, and calculated PCTc on the third day. Compared the two groups of group A and group B to find whether there were significant differences among PCT on the first day, hs-CRP, and WBC count. Compared the three groups of sepsis group, severe sepsis group and septic shock group to find whether there were significant differences among PCT on the first day, hs-CRP, WBC count and APACHEII score. Compared the three groups of G+group, G-group and fungal group to find whether there were significant differences among PCT on the first day, hs-CRP, and WBC count. Compared the two groups of survival group and nonsurvival group to find whether there were significant differences among PCT on the first day, PCT on the third day, PCTc on the third day, hs-CRP, WBC count and APACHEII score. By plotted ROC curve to calculate the AUC of each index. Used logistic regression analysis to assess independent impact of each index.Results: Group A compared with group B showed that PCT on the first day and hs-CRP between the two groups were statistically significant difference, WBC count between the two groups showed no significant difference; ROC curve analysis showed that PCT on the first day and hs-CRP have a certain value of early diagnosis for sepsis, AUC were 0.720?0.655 respectively. Compared sepsis group, severe sepsis group and septic shock group showed that PCT on the first day, hs-CRP, WBC count and APACHEII among the three groups and the differences between the two groups were statistically significant difference(P<0.05). ROC curve analysis displaied PCT on the first day compared with hs-CRP, WBC count and APACHEII had a higher value of diagnosis for severe sepsis, AUC were 0.908 ? 0.624 ? 0.709 ? 0.616 respectively; PCT on the first day compared with hs-CRP, WBC count and APACHEII had a higher value of diagnosis for septic shock, AUC were 0.937?0.712?0.753?0.607 respectively. Logistic regression analysis showed that PCT on the first day and WBC count were independent factors distinguish severity for sepsis. Compared G+ group, G- group and fungal group displaied that PCT on the first day, hs-CRP and WBC count among the three groups and the differences between the two groups were no significant difference. Survival group compared with nonsurvival group showed that PCT on the third day, PCTc on the third day, WBC count and APACHEII between the two groups was statistically significant difference, PCT on the first day, hs-CRP between the two groups showed no significant difference. ROC curve analysis showed that PCTc on the third day compared with PCT on the third day, WBC count and APACHEII had a higher value of assess prognosis for sepsis, AUC were 0.959?0.744?0.699?0.751 respectively. Logistic regression analysis showed that PCTc on the third day and APACHEII were independent risk factors of 28 days-mortality for septic patients.Conclusion: PCT and hs-CRP have a certain value of early diagnosis for sepsis, PCT is a better biomarker in diagnosis for sepsis. PCT, hs-CRP, WBC count and APACHEII score have some value of distinguish severity for sepsis, that increases with the severity of disease, PCT is a better biomarker in distinguish severity for sepsis. All the indicators have no value of identify microbial infection. PCT on the third day, PCTc on the third day, WBC count and APACHEII score have some values of assess prognosis for sepsis, PCTc on the third day compared with APACHEII had a higher value of assess prognosis for sepsis.