Abstract
INTRODUCTION: “Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to Infection”. Sepsis and septic shock are major healthcare problems and delay in definitive therapy is associated with an increased risk of multiorgan failure and Mortality. The inflammatory markers can help to predict the severity of sepsis, monitor the response to therapy and mortality. This prospective, comparative, observational study was planned for the evaluation of PCT, CRP, and IL-6 for the prognosis of Sepsis & Septic shock. OBJECTIVES: Prediction of severity, multiorgan failure and mortality in patients with sepsis and septic shock based on admission values of PCT, CRP and IL-6. MATERIALS AND METHODS: The present study was conducted in the Department of Critical Care Medicine, Dr BL Kapur Memorial Hospital, New Delhi. A total of 300 patients were enrolled in the study which met all inclusion criteria of the study. Blood samples were collected for routine lab investigations and biomarkers PCT, CRP, and IL-6 were collected on day 1(before administration of the first dose of antibiotic), day 3, day 7, and day 12. The APACHE II score was collected once only after 24 hours of ICU admission. SOFA score was done daily, however, SOFA scores of Days 1, 3, 7, and 12 only were taken into consideration. Blood culture and other body fluid culture as per the clinical condition. RESULTS: We found that out of 300 patients, 146(48.67%) patients with sepsis and 154(51.33%) with septic shock. Patients were also divided according to MOF and mortality. Out of 300 pateints 168(56.00%) patients with MOF & 132(44.00%) without MOF, and 187(62.33%) Survivor & 113(37.67%) Non-Survivor. MOF and the mortality rate are significantly higher in septic shock patients as compared to sepsis patients (p-value <0.0001). APACHE II and SOFA scores are significantly higher in septic shock patients, patients with MOF, and non-survivors as compared to patients with sepsis, without MOF, and survivors. PCT, Lactate, and SOFA remain statistically significantly higher in septic shock, patients with MOF, and non-survivor in all the time periods (Day 1,3,7,12). On the other hand, CRP and IL-6 are statistically significantly higher from day 3 in septic shock and MOF patients, while in non-survivor patients CRP is higher in all the time periods and IL-6 is higher from day 3. (p-value <0.05). On comparative analysis of serum biomarkers, Lactate and PCT are good predictors of septic shock, MOF, and non-survivor than CRP, and IL-6 based on AUC. CONCLUSION: The multiorgan failure and mortality rate are significantly higher in septic shock patients as compared to sepsis patients (p-value <0.0001). Serum biomarker Lactate and PCT are good predictors of septic shock, MOF, and mortality on admission. SOFA score and serum biomarkers-PCT, Lactate are significant independent risk factors of mortality in septic shock patients.