Title : Role of serial serum procalcitonin levels in predicting severity and outcome in sepsis and its utility in antibiotic stewardship at a tertiary care hospital
Abstract:
Introduction: Sepsis is a life-threatening condition caused by a dysregulated host response to infection resulting in organ dysfunction. Early diagnosis and risk stratification are crucial to reduce morbidity and mortality. Procalcitonin (PCT), a biomarker of bacterial infection, has gained importance for early diagnosis and monitoring treatment response. This study evaluates the role of serial serum procalcitonin levels in determining disease severity and prognosis in patients with sepsis and assess role of procalcitonin in guiding patient antibiotic therapy.
Aims
1. To evaluate the diagnostic and prognostic significance of serial PCT measurements (0 hr, 24 hr, 72 hr) in patients with sepsis.
2. To assess role of procalcitonin in guiding antibiotic therapy in patients with sepsis.
Materials and Methods: This prospective observational study included adult patients (>18 years) diagnosed with
sepsis as per Sepsis-3 criteria. Clinical and laboratory data including demographics, SOFA
score, infection source, antibiotic regimen, and serial PCT values at admission, 24 hours, and 72 hours were recorded. Patient outcomes were categorized as recovered, saved, or died. PCT kinetics were analyzed to determine trends and their relationship to mortality and antibiotic adjustments.
Results: A total of 1152 patients with infection were screened for sepsis of whom a total of 97 patients with complete clinical, laboratory, and treatment-related data were confirmed to have sepsis and were included in the final analysis. The majority of patients belonged to the 40–65 years age group (51.5%), followed by >65 years (33.0%), 25–40 years (10.3%), and 18–25 years (5.2%). A male predominance was observed with 56 males (57.7%) and 41 females (42.3%). Mean PCT levels demonstrated a progressive decline from admission to 24 hours and 72 hours. Patients who recovered showed a significant reduction in PCT levels (≥50–70% by 72 hours), indicating better therapeutic response. In contrast, non survivors had persistently elevated or rising PCT levels despite treatment. Antibiotic de-escalation was feasible and safe in patients with consistently declining PCT values. Mortality was highest among patients with admission PCT levels >10 ng/dL and those exhibiting minimal decrease over 72 hours, indicating poor prognosis. Regarding clinical outcomes, 79 patients (81.4%) recovered, while 18 patients (18.6%) succumbed to the illness. Mortality was predominantly observed in patients who had persistently elevated procalcitonin levels highlighting the prognostic value of procalcitonin in the assessment of septic patients.
Conclusion: Serial measurement of serum procalcitonin (PCT) is a valuable biomarker for the early diagnosis and monitoring of sepsis. In the present study declining PCT levels over 72 hours were associated with clinical improvement and favourable outcomes, whereas persistently elevated or rising PCT levels were associated with increased disease severity and higher mortality. This dynamic kinetic profile makes procalcitonin a valuable biomarker not only for diagnosis but also for monitoring treatment response .PCT-guided antibiotic de-escalation enhances antimicrobial stewardship and helps to effectively control the rising problem of antimicrobial resistance.
