The influence of early goal-directed therapy on procalcitonin expression in severe sepsis and septic shock

Abstract

Objective To evaluate the influence of early goal-directed therapy (EGDT) on procalcitonin expression in severe sepsis and septic shock,and optimize serum procalcitonin as a prognostic indicator of severe sepsis and septic shock.Methods 100 cases of severe sepsis and septic shock were collected from January 2012 to August 2013.All patients were divided into treatment group and control group according to predesigned project,50 cases in each group; these two groups were then subdivided into three groups based on the severity of global tissue hypoxia at enrolled time point,namely severe global tissue hypoxia group [lactate ≥ 4 mmol/L and central venous oxyhemoglobin saturation (ScvO2) ＜ 70％],moderate global tissue hypoxia group (2 mmol/L ≤ lactate ＜ 4.0 mmol/L and ScvO2 ＜ 70％) and resuscitation group/resolved global tissue hypoxia group (lactate ＜ 2 mmol/L and ScvO2 ≥ 70％).Patients' vital signs,ScvO2,CVP,blood lactate and serum procalcitonin were observed and recorded.Conducted acute physiology and chronic health evaluation (APACHE 1) within 24 h after enrollment,nultiple organ dysfunction score (MODS) and sequential organ failure assessment (SOFA) 1,2,3,7,14,21 and 28 d after enrollment.Evaluated the correlation between PCT and scores.Results PCT concentration in EGDT group exemplified patients' conditions and prognosis better,with statistically significant difference (P ＜ 0.05).Aggressive fluid resuscitation significantly reduced serum PCT expression in patients with severe sepsis and septic shock (P ＜ 0.01),and improved patients' condition and prognosis.Conclusion Serum procalcitonin is correlated with progress of severe sepsis and septic shock.Aggressive improvement of hemodynamic and oxygen supply (EGDT) can protect patients with severe sepsis and septic shock,and optimize PCT as a prognosis indicator. Key words: Severe sepsis and septic shock; Early goal-directed therapy; PCT