PROCALCITONIN AS A GAME-CHANGER? EARLY SEPSIS IDENTIFICATION IN PNEUMONIC PATIENTS IN CRITICAL CARE

Abstract

Background:
Sepsis remains a leading cause of morbidity and mortality in critical care, particularly among patients with pneumonia. Early and accurate identification of sepsis is crucial for timely intervention and improved outcomes. Conventional markers such as white blood cell count, C-reactive protein (CRP), and clinical scoring systems often lack specificity and may delay diagnosis. Procalcitonin (PCT), a peptide precursor of calcitonin, has emerged as a promising biomarker for early detection of bacterial infections and sepsis. However, its diagnostic utility in pneumonic patients within critical care settings requires further evaluation.

Objective:
This study aims to assess the diagnostic accuracy and clinical utility of serum procalcitonin levels in the early identification of sepsis among pneumonic patients admitted to critical care units.

Methodology:
A prospective cross-sectional study was conducted in the Intensive Care Units (ICUs) of a tertiary care hospital over 12 months. A total of 150 adult patients admitted with radiologically confirmed pneumonia were enrolled. Patients were categorized into septic and non-septic groups based on Sepsis-3 criteria. Serum procalcitonin levels were measured within 24 hours of ICU admission and compared between the groups. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of procalcitonin in detecting sepsis were calculated. Receiver Operating Characteristic (ROC) curve analysis was performed to determine the optimal PCT cut-off value for sepsis prediction.

Results:
Among 150 patients, 92 (61.3%) developed sepsis during their ICU stay. Median PCT levels were significantly higher in the septic group [5.8 ng/mL (IQR 3.2–10.5)] compared to the non-septic group [0.9 ng/mL (IQR 0.4–1.5)], with p < 0.001. ROC analysis yielded an AUC of 0.89 (95% CI: 0.83–0.94). A PCT cut-off value of ≥2.0 ng/mL demonstrated a sensitivity of 86.9%, specificity of 80.4%, PPV of 88.6%, and NPV of 77.5% for identifying sepsis. Early PCT-guided intervention was associated with shorter ICU stays and reduced antibiotic usage.

Conclusion:
Procalcitonin is a valuable biomarker for early identification of sepsis in pneumonic patients in critical care settings. Its high diagnostic accuracy supports its integration into sepsis screening protocols, potentially improving clinical outcomes through prompt intervention and antimicrobial stewardship.