Current Medicine Research and Practice (Jan 2011)
Do biochemical markers predict mortality in severe sepsis or septic shock?
Abstract
Background: Severe sepsis and septic shock are the leading causes of morbidity and mortality in the intensive care unit. The use of biomarkers may help in risk stratification and prediction of mortality in these patients. Objective: We observed the trends of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) values in patients with severe sepsis and septic shock and correlated those with 28-day mortality. Study design: This was a prospective, observational study. Participants: A total of 101 consecutive adult patients admitted to Sir Ganga Ram Hospital over 11 months (September 2007 to July 2008) with a fresh episode of severe sepsis or septic shock with expected duration of stay of >24 hours were included. Methods: PCT, IL-6 and CRP values at 0, 24 and 72 hours were taken and the outcome measure was mortality at 28 days. Results: The median age of enrolled subjects was 45 years. The mortality was 43.56% in patients admitted with severe sepsis or septic shock. The APACHE II score was significantly higher in non-survivor group with AUC 0.765 (95% CI 0.66, 0.86, p=0.000). Among the 3 biochemical markers at admission, AUC of IL-6 0.664 (95% CI 0.556, 0.772, p=0.005) was closest to that of APACHE II score. All parameters showed declining trends during the first 72 hours. However, among survivors only the PCT values showed a significant fall (p=0.001). Conclusion: Our study suggests that APACHE II score is a good predictor of mortality in patients with severe sepsis. However, among the studied biochemical markers, IL-6 at admission and a declining trend of PCT during the first 72 hours have a reasonable predictive ability.
