Evaluation of Triple Biomarker Algorithm for Identification of Bacterial Sepsis in Critical Care Patients of a Tertiary Care Hospital
Sarbjeet Sharma, Jaskiran Kaur
CRP, IL-6, CT, Infection, SIRS.
Citation Information :
Sharma S, Kaur J. Evaluation of Triple Biomarker Algorithm for Identification of Bacterial Sepsis in Critical Care Patients of a Tertiary Care Hospital. Curr Trends Diagn Treat 2018; 2 (1):9-14.
Introduction: Early and accurate identification of bacterial infection is crucial for the improved clinical outcome of a patient with sepsis, a diagnostic challenge in the intensive care unit (ICU). Virtually, all patients in the ICU have some inflammatory response associated with the fever which does not at all require antibiotics, thus differentiating between sepsis and non-infectious systemic inflammatory response syndrome (SIRS) is imperative. A study was therefore done to evaluate triple biomarker algorithm for identification of bacterial sepsis in critical care patients.
Materials and methods: One hundred and ninety-seven immunocompetent adult patients with presumed bacterial sepsis admitted in various ICUs of Sri Guru Ram Das University of Medical Sciences and Research were consecutively enrolled from November 2016 to October 2017. Blood samples obtained from these were subjected to culture and sensitivity as per clinical and laboratory standards institute (CLSI) guidelines in Department of Microbiology after approval by the ethical committee. Serial concentrations of C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) of 39 patients who fulfilled the inclusion criteria were determined at baseline, 24 hours, 48 hours and 72 hours in the Department of Biochemistry. The performance characteristic of various biomarkers individually and in combination was studied.
Results: Of the total 2831 adult indoor febrile patients, ICU admissions were 197/2831(6.9%) of which only 58/197(29.44%) were culture positive, yielding bacteria and Candida species in 52/58 (89.65%) and 6/58 (10.34%) respectively. There were significant (p < 0.05) difference in the levels of PCT and IL-6 among the bacteremic group.
Conclusion: Procalcitonin (PCT) and IL-6 are superior to CRP in the early identification of bacterial infection. However, more perspective and large-scale studies are warranted to confirm these findings.
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