Research Article

Diagnostic Value of Serum Procalcitonin and Diastolic Dysfunction for Evaluating the Mortality of Sepsis Patients Admitted in the Intensive Care

Abstract

Background: Sepsis is a serious condition that can be fatal and has become more common in recent times. The impact of diastolic dysfunction on the early mortality rate of septic patients has not been extensively researched. This study aimed to assess the accuracy of serum procalcitonin (PCT) levels and diastolic dysfunction in predicting the mortality rate of patients diagnosed with sepsis and admitted to the intensive care unit.
Methods: In this cross-sectional study, 40 sepsis patients admitted to the ICU were examined. Their characteristics were meticulously recorded using the APACHE II and SOFA score questionnaires, and only those who met the criteria underwent echocardiography. In order to evaluate the serum levels of PCT, it was required to take 40 ml of venous blood samples from the patients on the first and fifth days of admission.  
Results: Out of 40 patients, the average age was 63±17 years. Of these patients, 23 (57.5%) were discharged, while 17 (42.5%) unfortunately passed away. Results showed a notable correlation between diastolic dysfunction, CRP, SOFA score on days 1 and 2, APACHE II score, and PCT on day 5 (P˂0.05). However, when analyzed using logistic regression, only PCT on day 5 showed a significant association with mortality.
Conclusion: Based on our research, we found that PCT is an essential indicator in predicting the mortality rate of sepsis patients. While there was no significant correlation between diastolic dysfunction and mortality, it should still be considered a critical factor in determining the mortality rate.

[1] Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003. Crit Care Med. 2007; 35:1244–50.
[2] Casado-Flores J, Blanco-Quirós A, Asensio J, Arranz E, Garrote JA, Nieto M. Serum procalcitonin in children with suspected sepsis: a comparison with C-reactive protein and neutrophil count. Pediatr Crit Care Med. 2003; 4(2):190-5.
[3] Antonucci E, Fiaccadori E, Donadello K, Taccone FS, Franchi F, Scolletta S. Myocardial depression in sepsis: From pathogenesis to clinical manifestations and treatment. J Crit Care. 2014; 29:500–11.
[4] Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Critical Care. 1999; 3(1):45.
[5] Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med. 2008; 36:1701–6.
[6] Sturgess DJ, Marwick TH, Joyce C, Jenkins C, Jones M, Masci P, et al. prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers. Crit Care. 2010; 14:R44.
[7] Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J. 2012; 33:895–903.
[8] Hatzistilianou M. Diagnostic and Prognostic Role of Procalcitonin in Infections. Sci World J. 2010; 10:1941–6.
[9] Kruger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J. 2008; 31:349–55.
[10] Hillas G, Vassilakopoulos T, Plantza P, Rasidakis A, Bakakos P. C-reactive protein and procalcitonin as predictors of survival and septic shock in ventilator-associated pneumonia. Eur Respir J. 2010; 35:805–11.
[11] Ulla M, Pizzolato E, Lucchiari M, Loiacono M, Soardo F, Forno D, et al. Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study. Crit Care. 2013; 17:R168.
[12] Capuzzo M, Valpondi V, Sgarbi A, Bortolazzi S, Pavoni V, Gilli G, et al. Validation of severity scoring systems SAPS II and APACHE II in a single-center population. Intensive Care Med. 2000; 26:1779–85.
[13] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315:801.
[14] Rolando G, Espinoza EDV, Avid E, Welsh S, Pozo J Del, Vazquez AR, et al. Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock. Rev Bras Ter Intensiva. 2015; 27.
[15] Ognibene FP, Parker MM, Natanson C, Shelhamer JH, Parrillo JE. Depressed Left Ventricular Performance. Chest. 1988; 93:903–10.
[16] Cavazzoni SLZ, Guglielmi M, Parrillo JE, Walker T, Dellinger RP, Hollenberg SM. Ventricular Dilation Is Associated with Improved Cardiovascular Performance and Survival in Sepsis. Chest. 2010; 138:848–55.
[17] Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures. Circulation. 2000; 102:1788–94.
[18] Sevilla Berrios RA, O'Horo JC, Velagapudi V, Pulido JN. Correlation of left ventricular systolic dysfunction determined by low ejection fraction and 30-day mortality in patients with severe sepsis and septic shock: A systematic review and meta-analysis. J Crit Care. 2014; 29:495–9.
[19] Solomon SD, Anavekar N, Skali H, McMurray JJV, Swedberg K, Yusuf S, et al. Influence of Ejection Fraction on Cardiovascular Outcomes in a Broad Spectrum of Heart Failure Patients. Circulation. 2005;112:3738–44.
Files
IssueVol 9 No Supp. 1 (2023): Supplement 1 QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v9i5.13962
Keywords
Sepsis Procalcitonin C-Reactive Protein Left Ventricular Diastolic Dysfunction SOFA APACHE Mortality

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Hejazi ME, Samadi Takaldani AH, Ranjbar A, Negaresh M. Diagnostic Value of Serum Procalcitonin and Diastolic Dysfunction for Evaluating the Mortality of Sepsis Patients Admitted in the Intensive Care. Arch Anesth & Crit Care. 2023;9(Supp. 1):424-428.