Abstract
AIMS AND OBJECTIVES: Study the various biomarkers of sepsis and comparing procalcitonin - albumin ratio with SOFA Score and other available biomarkers: Procalcitonin, Albumin, C - reactive protein - albumin ratio, C - reactive protein, Creatinine, Total Leucocytes Count, and Platelet Count. Evaluate the biomarkers in diagnosis of sepsis and septic shock compared to clinical scoring system (SOFA score). Compare biochemical and haematological parameter in patient presenting with septic shock. Predict days of ICU stay and in-hospital mortality based on procalcitonin-albumin ratio and SOFA score at the time of admission. Association of co-morbidities with severity of sepsis and in-hospital mortality. Determine a cut off value of biomarkers to predict septic shock in patient diagnosed as sepsis. Suggestion to integrate procalcitonin- albumin ratio as a parameter along with SOFA score to predict severity of disease and outcome based on study. STUDY DESIGN: The study was a Prospective Observational, Cohort Study. MATERIALS AND METHODS: This study was undertaken on 63 patients admitted in the ICU Unit of Holy Family Hospital and Research Centre, Mumbai during the period of 1 year under the Department of Medicine and Intensive care. Detailed history, physical examination, and relevant investigations were done in the selected patients. All statistical tests were two tailed. Alpha (α) Level of Significance were be taken as P<0.05. The predictability of discriminating Septic shock from Non shock group was assessed using the area under the ROC curve (AUROC) at 95% Confidence Interval. ROC curve were plotted for Procalcitonin – Albumin ratio, SOFA score, CRP – albumin ratio and Leucocyte Count. RESULTS: This study showed that Procalcitonin - albumin ratio was significantly raised in patient of Sepsis who developed Septic shock as opposed to group who did not develop Septic shock. The result was superior to C - reactive protein – Albumin Ratio, Leucocyte count, Platelet count and Creatinine. At value of 0.955, PCT Albumin ratio had 84.21% sensitivity and 81.82% specificity. SOFA Score remained a superior diagnostic parameter to determine presence of Septic shock and severity of Sepsis when compared to biomarkers which were included in this study. There was no influence of Age, Sex and prior co morbidities on overall severity of Sepsis. Other Investigations like platelet count, C reactive protein, creatinine and leucocytes counts had no significant difference in septic shock and non shock group. There was no significant difference in overall days of ICU stay or mortality in septic shock and non - septic shock group. CONCLUSIONS: On the basis of our results we can conclude that SOFA score remains a superior tool for evaluating the severity of sepsis, However procalcitonin albumin Ratio can be used as a complementary diagnostic tool to SOFA score to predict overall severity of the disease and mortality. A Scoring system consolidating these parameters with SOFA score can be suggested and studied further.