Procalcitonina como um biomarcador no acompanhamento e prognóstico da sepse.

Abstract

Sepsis and failure of multiple organs and systems account for approximately 80% of all deaths in Intensive Care Units (ICUs). The presence of biomarkers in response to an infectious insult results in its use in screening, diagnosis, prognosis, monitoring of therapeutic response and the rational use of antibiotics. One of the biomarkers that is used in ICUs as a diagnosis and prognosis of sepsis is procalcitonin. The clinical determination of daily PCT in sepsis is useful during the septic process, there may be a marked increase in serum PCT, frequently indicating an exacerbation of the disease. In view of this context, the purpose of this study is to evaluate the utility of procalcitonin in the monitoring and prognosis of sepsis. A prospective, observational cohort study using blood collection to quantify procalcitonin from patients with sepsis in the adult ICU from August to November 2018. A retrospective study was also carried out to verify the frequency of sepsis in patients from the ICU-Adult of Santa Cruz Hospital in the city of Santa Cruz do Sul, Rio Grande do Sul, from February 2017 to September 2018. The methodology of this study was divided into three stages: Step 1, application of a questionnaire with the medical team of the HSC on the use and application of procalcitonin as a marker of prognosis and follow-up of severe patients hospitalized in intensive care units (ICU) adult and pediatric; in stage 2, follow-up of patients with sepsis and procalcitonin dosage (PCT); and in step 3, retrospective data collection of patients with sepsis from February 2017 to September 2018. Serum PCT assays were performed at the time of diagnosis. The results were analyzed in SPSS version 23.0, and expressed as mean ± standard deviation. In the questionnaire conducted by physicians and residents of the study Hospital on the usefulness of PCT, we verified that the usefulness of PCT as a marker of prognosis in sepsis and monitoring of the therapeutic response to antimicrobial therapy were the most voted. The PCT and CRP levels of three patients were measured at zero time of hospitalization and the mean PCT was 12.34 (SD = 17.24) and the PCR was 23.54 (SD = 11.33), both above normal value. In the collection of socio-demographic and clinical retrospective data, a total of 26 patients with sepsis in the ICU were diagnosed. There was a prevalence of males (53.8%), age over 60 years (84.6%), the majority of patients died (55.6%), diagnosed with community infection (81.5%), being the most common comorbidities were cardiac (74.1%). Regarding the SOFA score, the majority had a scale of 0 and 1 (88.5%). The mean total hospitalization was 7.54 (SD = 6.3) days. The CRP at the time of hospitalization 13.8 (SD = 11.64) and Lactate at the time of admission was 2.36 (SD = 0.96). The PCT and PCR of 3 patients at zero time of hospitalization were performed, but it was not possible to follow them, since they died within 24 hours. Mean of PCT and CRP were above normal values.