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Prognostic Utility of Delta-Procalcitonin and Modified Shock Index for Risk Stratification of Sepsis in Acute Care
Sanveer Singh1, Neeraj Singla1, Navneet Sharma1
1Department of Internal Medicine, Nehru Hospital, Post Graduate Institute of Medical Education & Research (PGIMER), R no 27, Level 4, Block F, Chandigarh, India.
Background:
Risk stratification in sepsis remains challenging, and while several scoring systems exist, there is a need for simple tools that can reliably predict outcomes.
Aims:
To study the role of Delta-Procalcitonin and Modified Shock Index (MSI) in predicting the severity of Multiple Organ Dysfunction Syndrome (MODS)like acute kidney injury, vasopressor requirement, need for mechanical ventilation, coagulopathy and 28 day mortality in sepsis.
Methods:
This prospective observational study recruited 122 patients with suspected sepsis. Delta-Procalcitonin was calculated by measuring the difference in procalcitonin values at the time of admission and after 48 h. Modified Shock Index (MSI) is calculated by "dividing heart rate by mean arterial pressure (MAP)." Procalcitonin and MSI were assessed by Receiver Operating Characteristic (ROC) curve analysis.
Results:
There's a statistically significant association between delta procalcitonin and the incidence of AKI (p = 0.035), the vasopressor requirement (p = 0.032), coagulopathy (p = 0.015) and no statistically significant association between delta procalcitonin and the need for renal replacement therapy (RRT) (p = 0.670), the mechanical ventilation requirement (p = 0.310), need for blood products (p = 0.57), number of organ dysfunctions(p = 0.344),and 28 day mortality (p = 0.138). The mortality rate was higher in the MSI ≥1.2 group (18.9%) compared to the MSI <1.2 group (11.5%).
Delta:
Procalcitonin was associated with predicting the severity of acute kidney injury, vasopressor requirement and coagulopathy. MSI had a statistically significant association with the prediction of vasopressor requirement, coagulopathy, and the number of organ dysfunctions.