Abstract
Calprotectin is a potent acute phase reactant with increases of more than 100 fold during inflamed conditions. We measured the diagnostic and prognostic value of serum calprotectin (SC) in septic shock. We enrolled 50 adult shocked patients admitted to intensive care unit. Then, classified into 2 groups; septic group (25) with well-defined septic shock with positive cultures. Non-septic group (25) with negative cultures or no source of sepsis. Blood samples for SC), C-reactive protein (CRP) and white blood cell count (WBCC) in the first 6 hours of ICU admission and re-obtained again on day 3. We observed the weaning of vasopressor and 7-days in ICU mortality. SC measured on day 1 was significantly higher in the septic group than the non-septic group (p<0.001). SC showed a good correlation with weaning of vasopressor (AUC was 0.764; p<0.028), while it showed relative correlation with 7-days in ICU mortality (AUC was 0.752; p<0.057) compared with other markers in the study. SC may aid in rapid identification of septic shock from non-septic shock at a cutoff of 2 µg/dl (sensitivity 92% and specificity 84%). Also the change in SC level may aid in prognostication of septic shock.
Highlights
[2] Severe sepsis and septic shock are associated with 30-60% mortality rate which is very high compared to other common diseases, such as myocardial infarction or breast cancer
Clinical criteria identifying such condition include the need for vasopressors to obtain a mean arterial pressure (MAP) ≥65 and an increase in lactate concentration more than two mmol/L, despite adequate fluid resuscitation. [4] 65The Sepsis-related Organ Failure Assessment (SOFA) score is widely used in the critical care setting and is a reliable tool to characterize septic patients clinically, but it requires some laboratory investigations. [4]
Up to the present day, little is known about the course of serum calprotectin (SC) levels over time and its relationship with development of sepsis, it was suggested by several studies as a potential marker for diagnosis in neonatal sepsis [28,29,30]
Summary
Sepsis is a major public health concern. [1] It is among the most common reason for admission to intensive care units (ICUs) throughout the world. [2] Severe sepsis and septic shock are associated with 30-60% mortality rate which is very high compared to other common diseases, such as myocardial infarction or breast cancer. [3] Sepsis is defined as a "life-threatening organ dysfunction due to a dysregulated host response to infection". Septic shock is defined as a "subset of sepsis where underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality". Clinical criteria identifying such condition include the need for vasopressors to obtain a mean arterial pressure (MAP) ≥65 and an increase in lactate concentration more than two mmol/L, despite adequate fluid resuscitation. Diagnosing sepsis is not always straightforward, especially in critically ill patients who often have complex ongoing disease processes Many of these patients will recently have received antimicrobial therapy that can render microbial cultures negative, even when cultures are positive, results are time consuming so it may delay the diagnosis. Many of these patients will recently have received antimicrobial therapy that can render microbial cultures negative, even when cultures are positive, results are time consuming so it may delay the diagnosis. [8-
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