Changes of procalcitonin, antithrombin III and D-dimer in patients with sepsis and its clinical significance

Abstract

Objective To determine the changes of procalcitonin (PCT) , antithrombin Ⅲ and D-dimer in patients with sepsis, and to investigate its clinical significance. Methods A total of 180 patients with sepsis, who were hospitalized in the Second Affiliated Hospital of Kunming Medical University between January 2014 and March 2016, and 180 patients with non-sepsis from a contemporary cohort, were included as the subjects in the study. According to the levels of PCT, the sepsis group was divided into the PCT<2.00 ng/ml group, 2.00 ng/ml≤PCT<10 ng/ml group and PCT≥10 ng/ml group. The venous blood was collected from all included patients. The prothrombin time (PT) , activated partial thromboplastin time (APTT) , thrombin time (TT) , fibrinogen (FIB) , D-dimer (DD) , antithrombin Ⅲ (AT-Ⅲ) and platelets (PLT) were determined. The acute physiology and chronic health score Ⅱ (APACHE Ⅱ) and sequential organ failure score (SOFA) were recorded at the first day of hospitalization. The change of coagulation function in different PCT levels and its correlation with the mortality and the morbidity of DIC were compared. The correlation between the APACHE Ⅱ score and SOFA score was compared. Patients with sepsis were divided into two groups according to whether they had DIC or not. The differences in the coagulation indexes between the two groups were compared. The value of AT-III for DIC diagnosis was evaluated. Results The levels of PT, APTT and TT in the sepsis group were longer than those in the non-sepsis group (P=0.028, P=0.031, P=0.042) , respectively. The PCT and DD in the sepsis group were higher than those in the non-sepsis group (P=0.000) , whereas the PLT and AT-III levels were lower than those in the non-sepsis group (P=0.001, P=0.000) , respectively. In patients with sepsis, in the PCT≥10 ng/ml group, the incidence of DIC (χ2=7.808, P=0.020) and mortality (χ2=-3.291, P=0.041) were high, the AT-III and PLT levels decreased, and the DD level increased, and there were statistically significant differences (P=0.048, P=0.029, P=0.000) . There was a negative correlation between AT and APACHE Ⅱ score and SOFA score (r=-0.813, r=-0.798) . DD was positively correlated with APACHE Ⅱ score and SOFA score (r=0.801, r=0.758) . AT-Ⅲ showed a certain diagnostic value for DIC (AUCROC=0.737) . Conclusion The levels of PCT, antithrombin Ⅲ and DD are related to the severity of sepsis, which may be an important index for the prognosis of sepsis. Key words: Sepsis; Antithrombin; D-dimer; Procalcitonin; DIC