RESUMO
Fever is the most frequent symptom of severe microbial infection.Together with abnormal temperature, tachycardia, Tachypnea and abnormal white blood cell count define the systemic inflammatory response syndrome [SIRS]. In 150 hospitalized medical patients with fever; clinical variables and laboratory markers as procalcitonin [PCT], elastase al-antitrypsin and lactoferrin levels in plasma were determined and evaluated for their diagnostic efficiency. Of the 150 patients, 95%had SIRS;of whom only 71% had clinical evidence of infection. On the otherhand only 45% of the patients enrolled in this study had microbial infection proved by microbiological testing . It was also found that clinical variables apart from Total WBC count and respiratory rate were non significant markers for microbial infection, because they lack sufficient specificity.Procalcitonin supranormal level was the most sensitive [70% initially and 75% after 24 hours] early laboratory marker followed by elastase al-antitrypsin [58% initially and 67% after 24 hours] for predicting microbial infection and bacteremia . Procalcitonin was also a predictor for mortality at 24 hours level [80%]followed by elastase al-antitrypsin [78%]. The thirdmarker , Lactoferrin can not be used as screening test because it showed the worst sensitivity both initially [32%]and at 24 hours[45%] for prediction of microbial infection as well as bacteremia [36%] initially and [45%]at 24 hours .It can be used as bad prognostic sign
Conclusion: In febrile medical patients plasma procalcitonin followed by elastase al-antitrypsin supranormal levels can predict early microbial infection and bacteremia as well as mortality better than do clinical symptoms. Thus allow early therapeutic treatment without the need of repeated blood culture as well as better outcome and survival