424 Available online at www.medicinescience.org ORIGINAL RESEARCH Medicine Science 2017;6(3):424-6 The importance of procalcitonin in early diagnosis of sepsis Funda Yetkin 1 , Sibel Altunisik Toplu 2 1 Inonu University Faculty of Medicine Department of Infectious Diseases, Malatya, Turkey 2 Malatya State Hospital, Infectious Diseases Clinic, Malatya, Turkey Received 03 November 2016; Accepted 26 December 2016 Available online 29.12.2016 with doi: 10.5455/medscience.2016.05.8582 Abstract Despite the advances and a wide range of studies conducted, sepsis is one of the most frequent causes of death in patients with critical health condition. Early diagnosis, rapid and effective treatment are extremely important. Use of procalcitonin (PCT) for this purpose has become widespread and notable recently. Procalcitonin is an important test as “point-of-care testing (POCT)” just like C-reactive protein (CRP). Procalcitonin is the prohormone of calcitonin. It is released from the parenchymal cells of the liver, kidneys and muscles, and in response to bacterial toxins, it is released from the adipocytes. As a response to bacterial infection, the serum procalcitonin level may increase by 5000-fold within 2-4 hours. C- reactive protein is synthesized in the liver as a result of interleukin-6 (IL-6) trigger due to tissue injury, inflammation and/or infections. The aim of our study was to emphasize the importance of PCT as an indicator in patients suspicious of sepsis in the early period. A total of 66 patients with critical situation were included in the study conducted at the İnönü University Medical Faculty Turgut Özal Medical Center Investigation Hospital between February 2007 and August 2008. These patients were appropriate for the diagnostic criteria of systemic inflammatory response syndrome (SIRS). Appropriate antibiotiotherapy was begun for the patients. The PCT and CRP levels were investigated on the first day after having been included in the study, and on the third and seventh days. The mean C-reactive protein levels were 132.41, 108.39 and 83.47 mg/l on the 1 st , 3 rd and 7 th days, respectively. The minimum level of procalcitonin was 0.095 ng/ml on the first day, and the maximum level was 316.054 ng/ml. The minimum/maximum levels were 0.091 and 306.043 ng/ml on the 3 rd day, and 0.081 and 12.15136 ng/ml on the 7 th days, respectively. No statistically significant difference was observed betweern the serum procalcitonin levels on the 1 st and the 3 rd days ( p<0.229), whereas a significant difference was observed between its levels between the 1 st and the 7 th days (p<0.002). Likewise, the difference between the 3 rd and the 7 th days was statistically significant (p<0.005). C-reactive protein levels revelaed a significant difference between the 1 st and the 7 th days (p<0.013) and between the 3 rd and the 7 th days (p<0.010). The Wilcoxon Signed test was used to investigate statistical significance. The diagnostic value of procalcitonin has been widely used in septic patients. Although conflicting results have been obtained in different studies, despite the fact that some studies have not found PCT supportive for the diagnosis of sepsis, we believe that PCT is an appropriate and important indicator in the early diagnosis and follow-up of sepsis as CRP. Keywords: Procalcitonin, early diagnosis, sepsis Introduction Early diagnosis and treatment dramatically increase the survival rates in sepsis. Procalcitonin (PCT) is an acute phase reactant. It is an important indicator in the diagnosis and treatment of sepsis. It was first detected in the medullary thyroid carcinoma cells [1]. Procalcitonin is formed of 116 amino acids, and is the precursor protein of calcitonin [2]. Under normal circumstances, PCT is transformed into calcitonin, catacalcin and N-terminal residues in a healthy individual. Therefore, it is in undetectable levels in the blood. However, it becomes detectable in the blood in severe bacterial infections and sepsis. The serum PCT concentration may reach 1000 ng/ml. Early detection of the increased PCT level is extremely important in the diagnosis and follow-up of the patients, and it is also useful [3]. The procalcitonin level is increased, particulary in bacterial infections and other septic conditions. This increase helps the clinician make a quick decision. Procalcitonin induction is fairly rapid. Initial levels increase within 2-6 hours, and reach a plateau within 6-12 hours. Its concentration remains elevated for up to 48 hours, and begins regressing in the subsequent 2 days [4]. The CRP increase becomes notable 4-6 hours after the stimulation by inflammation or infection, and makes a peak in 36-50 hours [5]. Materıals and Method A total of 66 patients with a critical situation were included in the study conducted at the İnönü University Medical Faculty Turgut Özal Medical Center Investigation Hospital between February 2007 and August 2008. The patients comprised 33 (50%) females and 33 (50%) males. The age range was 18-86 years. These patients met the diagnostic criteria of systemic inflammatory response syndrome (SIRS). Blood, urine, wound or the related samples of the patients were collected on admission for bacterial culture investigation. Appropriate antibiotherapy was started for the patients. The PCT and CRP levels were measured on the first day after inclusion, and on the 3rd and the 7th days. All data were recorded into the “Statistical Package *Coresponding Author: Sibel Altunisik Toplu, Malatya State Hospital, Infectious Diseases Clinic, Malatya, Turkey E-mail: saltuntoplu@gmail.com Medicine Science International Medical Journal