P9: THE ROLE OF PROCALCITONIN IN SEPSIS

Purpose of Study

This study will discuss the pathogenesis of sepsis, procalcitonin as a diagnostic prognostic marker for sepsis, other biomarkers of sepsis and sepsis treatment.

Methods Used

as required.

Summary of Results

Sepsis is a systemic immune response to infection by microbial organisms. Its complications are one of the leading causes of mortality. Mortality rate in sepsis remains high despite the current advances in medical science. Serum biomarkers like procalcitonin may aid in the early diagnosis of sepsis and therapeutic intervention.Procalcitonin belongs to a class of molecules, called “hormokines,” given the hormonal origin of the protein and the inflammation-related functions of its propeptides. Procalcitonin is a potent amplifier of the inflammatory cascade. It has shown that it induces pro-inflammatory like effects on leukocytes (increased the expression of surface markers), increases leukocyte-derived cytokines and also augments nitric oxide. Procalcitonin was found to be a more accurate diagnostic parameter for sepsis. A systemic review and meta-analysis revealed that procalcitonin has a mean sensitivity of 77% and specificity of 79%. Elevated level of procalcitonin was found to be a better predictor of mortality and identify patients at higher risk of adverse outcomes.Procalcitonin is found to be superior to C-reactive protein, TNF-α, Interleukins and Lactate levels in terms of accuracy at identifying sepsis and assessing the severity of sepsis. Implementation of a procalcitonin-guided antibiotic therapy in clinical setting was associated with a reduced duration of antibiotic therapy in septic patients without compromising clinical or economical outcomes.

Conclusions

Procalcitonin has been proved to be more reliable biomarker in diagnosing sepsis and predicting clinical outcome. Integrating use of procalcitonin in the early golden hours of sepsis diagnosis and antibiotic stewardship program would be beneficial.

This review identified the association of procalcitonin and sepsis. There is still a need for better understanding of how procalcitonin fits in the immune response, therefore further studies should be towards exploring the immunological role of procalcitonin in sepsis.

A population-based estimate of the burden of diarrhoeal illness in the United States: FoodNet, 1996-7

This study was performed to better understand and more precisely quantify the amount and burden of illness caused by acute diarrhoea in the United States today. A telephone-based population survey was conducted between 1 July, 1996, and 31 June, 1997, in sites of the Foodborne Diseases Active Surveillance Network (FoodNet). The overall prevalence of acute diarrhoea in the 4 weeks before interview was 11%, giving a rate of 1.4 episodes of diarrhoea per person per year. The rate of diarrhoeal illness defined as a diarrhoeal episode lasting longer than 1 day or which resulted in significant impairment of daily activities was 0.7 per person per year. It can be concluded that acute diarrhoea is common and represents a significant burden of illness in the United States. Our data on self-reported diarrhoea, when generalized to the entire nation, suggests 375 million episodes of acute diarrhoea each year in the United States. Many of these episodes are mild. However, our data also indicate that there are approximately 200 million episodes of diarrhoeal illness each year in the United States.

Prevalence of high-risk food consumption and food-handling practices among adults: a multistate survey, 1996 to 1997. The Foodnet Working Group

Risk factors for foodborne diseases include consumption of high-risk foods and unsanitary food-handling practices; however, little is known about the prevalence of these risk factors in the general population. A survey was done in five FoodNet sites (California, Connecticut, Georgia, Minnesota, Oregon) to determine the prevalence of these risk factors in the population. A total of 7,493 adults were interviewed by telephone between 1 July 1996 and 30 June 1997. Results showed that 1.5% drank raw milk, 1.9% ate raw shellfish, 18% ate runny egg, 30% preferred pink hamburger, 93% said they almost always washed their cutting board after cutting raw chicken, and 93% said they almost always washed their hands after handling raw meat or poultry, during 5 days before interview. The results differed by state and demographic group. Consumption of raw shellfish (3.2%) and undercooked hamburger (43%) were more common in Connecticut than other states. Raw milk consumption was more common among people who lived on a farm (8.6%) compared with people who lived in a city or urban area (1.1%). Preference for undercooked hamburger was more common among men (35%), young adults (18 to 25 years, 33%), people with college education (38%), and among people with household income of more than $100,000/year (49%). African-Americans were less likely to prefer undercooked hamburger compared to other racial groups (10% versus 30%). Young adults compared to older adults were less likely to wash their hands after handling raw chicken (88% versus 95%), and men washed their hands less often than women (89% versus 97%). Although there were statistical differences between demographic groups, they are insufficient to warrant targeted educational programs.

Incidence of foodborne illnesses reported by the foodborne diseases active surveillance network (FoodNet)-1997. FoodNet Working Group

In 1997, the Foodborne Diseases Active Surveillance Program (FoodNet) conducted active surveillance for culture-confirmed cases of Campylobacter, Escherichia coli O157, Listeria, Salmonella, Shigella, Vibrio, Yersinia, Cyclospora, and Cryptosporidium in five Emerging Infections Program sites. FoodNet is a collaborative effort of the Centers for Disease Control and Prevention's National Center for Infectious Diseases, the United States Department of Agriculture's Food Safety and Inspection Service, the Food and Drug Administration's Center for Food Safety and Applied Nutrition, and state health departments in California, Connecticut, Georgia, Minnesota, and Oregon. The population under active surveillance for foodborne infections was approximately 16.1 million persons or roughly 6% of the United States Population. Through weekly or monthly contact with all clinical laboratories in these sites, 8,576 total isolations were recorded: 2,205 cases of salmonellosis, 1,273 cases of shigellosis, 468 cases of cryptosporidiosis, 340 of E. coli O157:H7 infections, 139 of yersiniosis, 77 of listeriosis, 51 of Vibrio infections, and 49 of cyclosporiasis. Results from 1997 demonstrate that while there are regional and seasonal differences in reported incidence rates of certain bacterial and parasitic diseases, and that some pathogens showed a change in incidence from 1996, the overall incidence of illness caused by pathogens under surveillance was stable. More data over more years are needed to assess if observed variations in incidence reflect yearly fluctuations or true changes in the burden of foodborne illness.

The investigation and outcome of reported cases of elder abuse: the Forsyth County Aging Study

This study summarizes the outcome of all investigations of elder abuse conducted in Forsyth County, North Carolina, during a 3-year period ending December 1991. Of the 123 cases investigated, 23 were confirmed as elder abuse. There were no statistically significant differences in age, sex, race, living arrangements, mental status, mobility, or source of report between confirmed and unconfirmed cases. Unconfirmed compared to confirmed cases were more likely to reside in a nursing home and/or to be ill. The most frequently substantiated charge was exploitation of resources (46%). Only 3% of charges of physical abuse were substantiated. Among confirmed cases, 70% were offered and accepted protective services.