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VOLUME 7 , ISSUE 3 ( September-December, 2022 ) > List of Articles

Original Article

Correlation of C-reactive Protein, Procalcitonin, and Lactate Levels with Mortality in Sepsis

Pallaavi Goel, Puneet Rijhwani, Sumeet Garg, Ram K Jat, Mukesh K Sarna, Pardeep Agarwal, Somesh Gupta, Ambika Tyagi

Keywords : C-reactive protein, Lactate, Procalcitonin, Sepsis

Citation Information : Goel P, Rijhwani P, Garg S, Jat RK, Sarna MK, Agarwal P, Gupta S, Tyagi A. Correlation of C-reactive Protein, Procalcitonin, and Lactate Levels with Mortality in Sepsis. J Mahatma Gandhi Univ Med Sci Tech 2022; 7 (3):75-77.

DOI: 10.5005/jp-journals-10057-0216

License: CC BY-NC 4.0

Published Online: 16-09-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Background: There is no gold standard tool to definitively diagnose sepsis and no consistent system to predict outcomes. In any clinical setup, laboratory biomarkers are very important and can serve in determining the suitable treatment course. Serum lactate is one of these biomarkers that is known to be linked with mortality in patients with sepsis. Even procalcitonin (PCT) has been said to be a biomarker very useful in diagnosing sepsis. C-reactive protein (CRP) is an acute phase reactant and another sensitive marker of sepsis. Materials and methods: A prospective observational study was conducted in a tertiary care center in Jaipur, Rajasthan, India, including 160 study participants who were admitted to the intensive care unit (ICU) and diagnosed with sepsis. Detailed history and examination were made, followed by blood investigations. Written informed consent was obtained from all participants, and Institutional Ethics Committee approval was taken at the beginning of the study. Statistical analysis was done after adequate data collection. Results: Mean CRP (mg/L) was 9 ± 1.41, mean PCT (ng/mL) was 1.6 ± 0.56, and mean lactate (mmol/L) was 2.1 ± 1.97 among the study subjects. Mean CRP was found to be significantly higher in expired subjects (77 ± 31.1) as compared to survivors (9 ± 1.41). This difference was statistically significant as p < 0.05. Mean PCT (ng/mL) was found to be significantly higher in expired subjects (11.1 ± 0.14) as compared to survivors (1.6 ± 0.56). This difference was statistically significant as p < 0.05. Mean serum lactate was found to be higher in expired (3.4 ± 0.77) subjects as compared to survivors (2.1 ± 1.97), but this difference was not statistically significant as p > 0.05. Conclusion: The combined biomarker approach using CRP, PCT, and lactate depicted a better performance in predicting 28-day mortality.

  1. Lever A, Mackenzie I. Sepsis: definition, epidemiology, and diagnosis. BMJ 2007;335(7625):879–883. DOI: 10.1136/bmj.39346.495880.AE
  2. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287
  3. Strehlow MC, Emond SD, Shapiro NI, et al. National study of emergency department visits for sepsis, 1992 to 2001. Ann Emerg Med 2006;48(3):326–331. DOI: 10.1016/j.annemergmed.2006.05.003
  4. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017;43(3):304–377. DOI: 10.1007/s00134-017-4683-6
  5. Marshall JC. Sepsis: rethinking the approach to clinical research. J Leukoc Biol 2008;83(3):471–482. DOI: 10.1189/jlb.0607380
  6. Anush MM, Ashok VK, Sarma RI, et al. Role of C-reactive Protein as an Indicator for Determining the Outcome of Sepsis. Indian J Crit Care Med 2019;23(1):11–14. DOI: 10.5005/jp-journals-10071-23105
  7. Arora S, Singh P, Singh PM, et al. Procalcitonin Levels in Survivors and Nonsurvivors of Sepsis: Systematic Review and Meta-Analysis. Shock 2015;43(3):212–221. DOI: 10.1097/SHK.0000000000000305
  8. Liu D, Su L, Han G, et al. Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis. PLoS One 2015;10(6):e0129450. DOI: 10.1371/journal.pone.0129450
  9. Mikkelsen ME, Miltiades AN, Gaieski DF, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 2009;37(5):1670–1677. DOI: 10.1097/CCM.0b013e31819fcf68
  10. Filho RR, Rocha LL, Corrêa TD, et al. Blood lactate levels cutoff and mortality prediction in sepsis-time for a reappraisal? A retrospective cohort study. Shock 2016;46(5):480–485. DOI: 10.1097/SHK.0000000000000667
  11. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101(6):1644–1655. DOI: 10.1378/chest.101.6.1644
  12. Song J, Moon S, Park DW, et al. Biomarker combination and SOFA score for the prediction of mortality in sepsis and septic shock: A prospective observational study according to the Sepsis-3 definitions. Medicine (Baltimore) 2020;99(22):e20495. DOI: 10.1097/MD.0000000000020495
  13. Garbero RF, Simões AA, Martins GA, et al. SOFA and qSOFA at admission to the emergency department: Diagnostic sensitivity and relation with prognosis in patients with suspected infection. Turk J Emerg Med 2019;19(3):106–110. DOI: 10.1016/j.tjem.2019.05.002
  14. Gaini S, Relster MM, Pedersen C, et al. Prediction of 28-days mortality with sequential organ failure assessment (SOFA), quick SOFA (qSOFA) and systemic inflammatory response syndrome (SIRS) - A retrospective study of medical patients with acute infectious disease. Int J Infect Dis 2019;78:1–7. DOI: 10.1016/j.ijid.2018.09.020
  15. Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Crit Care 2014;18(5):503. DOI: 10.1186/s13054-014-0503-3
  16. Hu C, Zhou Y, Liu C, et al. Pentraxin-3, procalcitonin and lactate as prognostic markers in patients with sepsis and septic shock. Oncotarget 2018;9(4):5125–5136. DOI: 10.18632/oncotarget.23701
  17. Pallás Beneyto LA, Rodríguez Luis O, Saiz Sánchez C, et al. [Prognostic value of interleukin 6 for death of patients with sepsis]. Med Clin (Barc) 2016;147(7):281–286. DOI: 10.1016/j.medcli.2016.06.001
  18. Shukeri WFWM, Ralib AM, Abdulah NZ, et al. Sepsis mortality score for the prediction of mortality in septic patients. J Crit Care 2018;43:163–168. DOI: 10.1016/j.jcrc.2017.09.009
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