LEVEL OF PROCALCITONIN PLASMA AS AN EARLY SEPSIS BIOMARKER IN POLYTRAUMA PATIENTS IN DR HASAN SADIKIN GENERAL HOSPITAL BANDUNG
Downloads
Background: Polytrauma patients have a risk of progressive organ dysfunction due to uncontrolled immunological process. Sepsis and multiple organ failure are the most common causes of morbidity and mortality in late death of polytrauma patients. Clinical diagnosis and routine laboratory test are not specific until the patient entered a critical state. Delayed diagnosis of sepsis is caused by difficulties in diagnosing. Procalcitonin is a biomarker that is useful in predicting the onset of sepsis. The aim of this research is to determine the level of procalcitonin as early biomarker sepsis in polytrauma patients in RSHS Bandung.
Methods: A diagnostic study using secondary data from the Academic Leadership Grant (ALG) study on polytrauma patients in Emergency Room of RSHS Bandung from January-June 2017. This study determined the cut of point, sensitivity, spesificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy to diagnosis sepsis.
Result: A total of 70 subjects were enrolled in this study, 92.9% were male gender with average age 33.21±13.395 years old. Twenty-one patients (30%) were diagnosed with sepsis. Based on receiver operating characteristic (ROC) curve showed the level of procalcitonin was given in the area under curve (AUC) 0.96 with Confidence Interval 0.923-1.00 (p < 0.05). The Procalcitonin cut of point was 1.46 ng/mL with a sensitivity of 90.5%, specificity of 89.8%, PPV of 79.2%, NPV of 95.7%, and accuracy of 90.0%.
Conclusion: Plasma Procalcitonin 1.46 ng/mL is a good predictor for early diagnosis sepsis toward polytrauma patients.NCIPC. Injury Response: Global Trauma Care. http://www. cdc.gov/traumacare/global_trauma.html.
World Health Organization. Injuries and violence : the fact. J Trauma. 2014.
Korlantas Polri. Angka kecelakaan lalu lintas tahun lalu naik. [Diunduh: 25 Januari 2017]. Tersedia dari: http://www.korlantas.polri.go.id.
Giannoudis PV. Polytrauma : pathophysiology, priorities, and management : AO Principles of fracture management.3rd edition.AO Foundation. Thieme.2017;p311-330.
Rady MY, Rivers EP, Nowak RM: Resuscitation of the critically ill in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med 1996, 14:218-225.
Dunham CM, Siegel JH, Weireter L, Fabian M, Goodarzi S, Guadalupi P, Gettings L, Linberg SE, Vary TC: Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock. Crit Care Med 1991, 19:231-243.
Sinaga B, Mahadewa T.G, Maliawan S. High blood levels procalcitonin as systemic inflammatory response syndrome predictor in severe and moderate head injury. Bali Medical Journal. 2014; 3(1) : 25-30.
Ciriello V, Gudipati S, Stavrou PZ, Kanakaris NK, Bellamy MC, Giannoudis PV. Biomarkers predicting sepsis in polytrauma patients: Current evidence. Injury 2013;44:1680-92.
Billeter A, Turina M, Seifert B, Mica L, Stocker R. Early serum procalcitonin, Interleukin-6, and 24-hour lactate clearance: Useful indicator of septic infections in severely traumatized patients. World J Surg 2009;33:558-566
Levy MM, Fink MP, Marshall JC, et al. SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29(4):530-8.
Grissom CK, Brown SM, Orme JF. A Modified Sequential Organ Failure Assessment (MSOFA) score for critical care triage. Disaster Med Public Health Prep. 2010; 4(4).
Morgenthaler NG, Struck J, Fischer-Shculz C, et al. A detection of procalcitonin in healthy controls and patients with local infection by a sensitive ILMA. Clin Lab 2002;48:263-270.
Meisner M, Procalcitonin Biochemistry and Clinical Diagnosis. 1st edition. Bremen : UNI-MED, 2010;p9-36 (32)
Badan Penelitian dan Pengembangan Kesehatan. (2018). Riset Kesehatan Dasar (Riskesdas) 2013: Laporan Nasional. Jakarta: Badan Litbangkes Depkes.
Oyeniyi BT, Fox EE, Scerbo M, Tomasek JS, Wade CE, Holcomb JB. Trends in 1029 trauma deats at level trauma center : Impact of a bleeding control bundle of care. Injury. 2017;48: 5-12.
ASEAN Regional Road Safety Strategy pdf. 21th ASEAN Transport Ministers Meeting. 2015.
Wafaisade A, Lefering R, Bouillon B, Sakka SG, Thamm OC, Paffrath T, et all. Epiemiology and risk factors of sepsis after multiple trauma : an analysis of 29.829 patients from the Trauma Registry of the German Society for Trauma Surgery. Crit Care Med 2011; 39(4).
Meisner M, Tschaikowsky K, Palmaers T, et al. Comparison of procalcitonin and C-reactive protein plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999;3:45-55
Dahlan MS. Analisis Penelitian Diagnostik. Dalam: Penelitian Diagnostik. Edisi ke-1. Jakarta:Salemba Medika; 2009. p19–30.
- The author acknowledges that the copyright of the article is transferred to the Journal of Orthopaedi and Traumatology Surabaya (JOINTS), whilst the author retains the moral right to the publication.
- The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution-Non Commercial-Share Alike 4.0 International License (CC BY-NC-SA).
- All published manuscripts, whether in print or electronic form, are open access for educational, research, library purposes, and non-commercial uses. In addition to the aims mentioned above, the editorial board is not liable for any potential violations of copyright laws.
- The form to submit the manuscript's authenticity and copyright statement can be downloaded here.
Journal of Orthopaedi and Traumatology Surabaya (JOINTS) is licensed under a Creative Commons Attribution-Non Commercial-Share Alike 4.0 International License.
Journal Orthopaedi and Traumatology Surabaya (JOINTS) (