Procalcitonin versus C-reactive protein: Usefulness as biomarker of sepsis in ICU patient.

BACKGROUND: Early diagnosis and appropriate therapy of sepsis is a daily challenge in intensive care units (ICUs) despite the advances in critical care medicine. Procalcitonin (PCT); an innovative laboratory marker, has been recently proven valuable worldwide in this regard. OBJECTIVES: This study was undertaken to evaluate the utility of PCT in a resource constrained country like ours when compared to the traditional inflammatory markers like C - reactive protein (CRP) to introduce PCT as a routine biochemical tool in regional hospitals. MATERIALS AND METHODS: PCT and CRP were simultaneously measured and compared in 73 medico-surgical ICU patients according to the American College of Chest Physicians (ACCP) criteria based study groups. RESULTS: The clinical presentation of 75% cases revealed a range of systemic inflammatory responses (SIRS). The diagnostic accuracy of PCT was higher (75%) with greater specificity (72%), sensitivity (76%), positive and negative predictive values (89% and 50%), positive likelihood ratio (2.75) as well as the smaller negative likelihood ratio (0.33). Both serum PCT and CRP values in cases with sepsis, severe sepsis and septic shock were significantly higher from that of the cases with SIRS and no SIRS (P < 0.01). CONCLUSION: PCT is found to be superior to CRP in terms of accuracy in identification and to assess the severity of sepsis even though both markers cannot be used in differentiating infectious from noninfectious clinical syndrome.

Comparison of values of traditionally measured venous bicarbonate with calculated arterial bicarbonate in intensive care unit patients of a hospital in a third-world country.

BACKGROUND: Measurement of serum or plasma bicarbonate (HCO3 (-)) from a sample of peripheral venous blood is routinely practiced in hospital patient managements. HCO3 (-) status can also be obtained by a simple calculation during blood gas analysis requiring arterial blood as sample which is cumbersome for both patient and doctor. This study compared the measured bicarbonate levels with calculated arterial values in intensive care unit (ICU) patients to determine whether traditionally measured venous HCO3 (-) and calculated HCO3 (-) values [from arterial blood gas (ABG) analyzers] can be used interchangeably. MATERIALS AND METHODS: This prospective study was carried out at a tertiary care teaching hospital in Dhaka, the capital of Bangladesh. A total of 56 adult patients with diverse medical conditions, presenting at the ICU of the health centre were enrolled in this study when deemed by the treating physician to have an ABG analysis. Arterial and venous samples were taken as close in time as possible for gas analysis and routine blood tests. RESULTS: The HCO3 (-) levels from ABG and traditionally measured serum showed acceptably narrow 95% limits of agreement using the Bland-Altman method. CONCLUSIONS: More widely prescribed venous HCO3 (-) measurements can also be a useful substitute for an expensive ABG analyzer in resource-constrained health care sectors when required. However, accuracy of venous blood in assessment of additional ABG parameters is yet to be discovered.