Role of Procalcitonin and C-reactive protein in differentiating culture negative bacterial sepsis and systemic inflammatory response

Background: It is very important to distinguish between non-infectious systemic inflammatory response (SIRS) and culture negative sepsis as the management of the two conditions is different this often creates diagnostic challenge in day to day practice. The aim of present study is to investigate the diagnostic accuracy of serum PCT and CRP to differentiate between culture negative bacterial sepsis and non-infective SIRS. We have also studied their diagnostic efficacy in culture-positive sepsis. Materials and methods: 178 cases who were admitted in acute medical care unit in tertiary care centre, were included in the study. The cases were divided into three groups. Group I (culture positive sepsis) patients with positive microbial culture and 2 or more signs of sepsis. Group II (culture negative sepsis) includes patients with 2 or more sign of SIRs and clinical suspicion of infection with negative culture result. Group III (non-infective SIRs) includes patient with 2 or more sign of SIRS without evidence of any infection. Samples were collected for blood culture, differential count, PCT and CRP along with other routine investigation. The diagnostic performance of PCT and CRP was demonstrated with ROC curve analysis. Results: The median Procalcitonin was approximately 9 fold higher in culture negative group compared to non-infective SIRS and it was statistically significant (P<0.01) whereas CRP showed Siraj Ahmed Khan, Iyyapu Krishna Mohan, Bhavya Sirivelu, Rachel Jacob. Role of Procalcitonin and C-reactive protein in differentiating culture negative bacterial sepsis and systemic inflammatory response. IAIM, 2017; 4(3): 24-29. Page 25 only 2-3 fold increase between these groups. ROC curve analysis for PCT and CRP between culture negative and SIRS groups for prediction of systemic infection were performed. The area under the curve for PCT and CRP were 0.986 and 0.785 respectively. Conclusion: Biomarkers such as PCT and CRP are strongly associated with infection likelihood and sepsis and they can serve as useful adjuncts to routine clinical information. These markers were also able to distinguish between patients with non-infective SIRS and sepsis.

Leukemia as a second malignancy.

To study the occurrence of leukemia as a second malignancy following various primary solid and hematological malignancies. Total 11 cases of leukemia presenting as a second malignancy were studied over a period of 15 years from 1990 to 2005. The primary malignancies included carcinoma breast (4), multiple myeloma (3) and one each of Hodgkin's lymphoma, mediastinal germ cell tumor, papillary carcinoma thyroid and myxopapillary ependymoma. Ten patients had received chemotherapy with combination radiotherapy in six patients. The commonest type of leukemia was AML-M2. The cyogenetic test results were available in three cases. The secondary leukemia showed aggressive behaviour and all patients on follow-up died within a period of one month. The risk benefit ratio of chemotherapy and radiotherapy should be considered before starting the patients on treatment. A high degree of suspicion and follow up with hematological parameters is required for therapy related complications.

Cytogenetic profile of chronic myeloid leukemias.

Chronic Myeloid leukemia is a clonal disease of multipotent haematopoietic cells associated with specific cytogenetic changes involving a translocation t(9;22) (q34:q11), more commonly known as Philadelphia Chromosome (Ph1). A total of 525 patients with CML (480 adults and 45 children) diagnosed at the Nizam's Institute of Medical Sciences, Hyderabad, formed the subjects of this study. Hematological investigations were carried out using standard methods. Unstimulated peripheral blood samples and/or bone marrow aspirates were used for cytogenetic analysis. Hematological evaluation at presentation showed that 435 were in chronic phase, 36 in accelerated phase and 54 in blast crisis. Chromosomal analysis revealed that 86.3% were Ph1 positive and 13.7% Ph1 negative. Additional chromosome changes observed during blast crisis included an extra Ph1 chromosome, Trisomy 8 and Trisomy 19. The results were correlated with survival pattern and prognosis of patients following certain treatment protocols.