ROLE OF INFLAMMATORY BIOMARKERS IN EARLY DETECTION OF SEPSIS AMONG TRAUMA ICU PATIENTS

Abstract

Sepsis is leading to potentially preventable morbidity and mortality in critically injured patients, and its early diagnosis is difficult because it shares the same clinical features with sterile inflammation. The diagnostic accuracy of inflammatory markers for sepsis in trauma ICU patients was the objective of this study in Pakistani patients. During (May 2024- April 2025) prospective observational cohort design was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi. One hundred and eighty adult trauma patients fulfilling the inclusion criteria were recruited prospectively with baseline demographic and clinical information collected in addition to sequential biomarker collection. Blood samples were obtained at entry time (0 h), and 24 h, 48 h, 72 h after randomization to determine procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). The diagnosis of sepsis was based on Sepsis-3 criteria, and statistical analyses, such as receiver operating characteristic (ROC) curve analysis, and bio score modeling were executed with SPSS 26.0. There was a 32.2% (n=58) incidence of sepsis, which was associated to longer Intensive Care Unit (ICU) stay (median 12 [Interquartile Range (IQR) 19] vs 7 [IQR 17] p<0.001), higher need for mechanical ventilation (70.7 vs. 40.2%, p<0.001) and ICU mortality (31.0 vs 9.8%, p<0.001) than in non-sepsis patients. The kinetics of the biomarkers showed significantly elevated concentrations of PCT, IL-6, CRP and TNF-α at all time points in the sepsis group (p<0.001). The diagnostic accuracy of IL-6 (Area Under the Curve (AUC) =0.93, sensitivity=90.2%, specificity=85.6%) and PCT (AUC = 0.91, sensitivity =88.5, specificity = 84.2%) was significantly higher than that of CRP (AUC=0.79) and TNF-α (AUC=0.81). Ingestion of IL-6 and PCT had robust association with severity of sepsis by correlation analysis: r=0.76 and 0.72, respectively. The integrated biomarker bio-scores were of better diagnostic values and the predict power of the comprehensive three-biomarker combination (PCT+IL-6+CRP) was of the best (AUC=0.96, sensitivity=92.7%, specificity=89.6%). Our current study provides robust evidence that grouping of IL-6 and PCT should be considered as primary biomarkers in the early diagnosis of sepsis in trauma IUC as the early stage of bio detection can enhance the predictive power of diagnosis. The findings emphasize the need to incorporate context-specific biomarkers into sepsis surveillance and treatment considerations in LMICs.