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 Table of Contents  
CLINICAL QUERIES
Year : 2017  |  Volume : 15  |  Issue : 3  |  Page : 168

Clinical questions: Responses to clinical queries from readers: Procalcitonin in Sepsis


Department of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication7-Aug-2017

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-4651.212404

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How to cite this article:
Chacko B, George TK. Clinical questions: Responses to clinical queries from readers: Procalcitonin in Sepsis. Curr Med Issues 2017;15:168

How to cite this URL:
Chacko B, George TK. Clinical questions: Responses to clinical queries from readers: Procalcitonin in Sepsis. Curr Med Issues [serial online] 2017 [cited 2017 Sep 25];15:168. Available from: http://www.cmijournal.org/text.asp?2017/15/3/168/212404

Question 3

What would be a reliable marker(s) of sepsis? Many are depending on procalcitonin in treatment of high-grade fever, is it a reliable marker of sepsis?

What is the role of ulinastain (which is very expensive), if the value of procalcitonin is high?

Answer

Sepsis, while among the most common reasons for admission to Intensive Care Units worldwide, suffers from the lack of a gold standard for diagnosis. This makes it difficult to calculate sensitivity and specificity of any test.

Procalcitonin - over the past decade - has been studied in two different situations:

  1. As a biomarker for the diagnosis of sepsis
  2. To guide therapy.


In the first situation, as shown in the meta-analyses by Tang et al. and Wacker et al., the sensitivity and specificity of this test ranges from 71% to 79%.[1] Given this, it is advised that procalcitonin value should not be looked at in isolation but in keeping the entire clinical situation in perspective.[2]

In the second situation, serial procalcitonin monitoring in the PRORATA trial [3] has been shown to decrease antibiotic duration with no change in outcome. This benefit of decreasing antibiotic usage, however, depends on the clinician willingness to stop antibiotics and antibiotic stewardship programs.

At this point of time, clinical utilization of procalcitonin is limited to guiding duration of antibiotic therapy.

With regard to ulinastatin prescription in sepsis, in our institution, we are slow to use new therapies unless there is a clear evidence of benefit to the patient. A good example of not jumping to use new therapy is activated protein C, which was ultimately found to be harmful in the PROWESS SHOCK study in 2012.

While ulinastatin was shown to decrease mortality in sepsis in the article quoted in the question,[4] we need to cautious in interpreting this given very wide confidence intervals (odds ratio: 0.26, 95% confidence interval: 0.07–0.95; P = 0.042). In addition, there was no mortality benefit in the intention to treat analysis.

Therapy targeting the inflammatory and coagulation cascade of sepsis has not been shown to be convincingly beneficial, safe, and cost-effective for the patient use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




 

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