Early recognition of sepsis is of particular interest, because this could expedite the initiation of early specific treatment and could potentially improve patient outcome. The aim of this study was to determine the value of procalcitonin (PCT), white blood cell count (WBC), IL-6, terminal complement complex (C5b-9) and C-reactive protein (CRP) in the prediction of postoperative sepsis.
In a prospective clinical observational study 72 non-infected patients admitted postoperatively to an ICU who required > 24 hours ICU treatment were recruited. Blood samples were collected on the first, second, third, fifth, seventh and 10th day. Each patient was examined daily for signs and symptoms of infection. Values were given as median and interquartile range (IQR). Diagnostic accuracy of the parameter determined at study entry was expressed as the area under the receiver-operating curve (AUC).
Of 72 recruited patients 11 developed postoperative sepsis and 18 severe sepsis or septic shock. Infection was microbiology proven in 22 of 29 patients (76%). The patients enrolled had an age of 68 (21.5) years and an initial SOFA score of 5 (4). After 28 days, 12 patients had died, 60 were survivors.
Our results indicate that in postoperative patients prior to the onset of any clinical deterioration PCT may be a specific predictive marker and IL-6 may be a sensitive predictive marker for sepsis.
Table 1. Diagnostic performance of markers to predict sepsis on inclusion day
This study was supported by grants from the R&D RLBUH NHS Trust support fund and from the R&D fund of the University of Liverpool.