Sepsis

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Divisi Tropik Infeksi SMF Ilmu Penyakit Dalam

RSU Ulin Banjarmasin
Tatalaksana sepsis
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 Procalcitonin
• Under normal physiological conditions, active CT is produced and secreted
in the C-cells of the thyroid gland after proteolytic cleavage of PCT,
meaning, in a healthy individual, that PCT levels in circulation are very low
(<.05 ng/mL).
• Bacterial infections induce a universal increase in the CALC-1 gene
expression and a release of PCT (>1 μg/mL)
• it has become a marker to improve bacterial infections identification and
guide antibiotic therapy.
• Measurement of procalcitonin can be used as a marker of
severe sepsis caused by bacteria and generally grades well with the degree
of sepsis
• PCT has the greatest sensitivity (85%) and specificity (91%) for
differentiating patients with systemic inflammatory response
syndrome (SIRS) from those with sepsis,
• Procalcitonin levels may be useful to distinguish bacterial infections from
nonbacterial infections.
• The level of procalcitonin in the blood stream of healthy individuals is
below the limit of detection (0.01 µg/L) of clinical assays
• The level of procalcitonin rises in a response to a proinflammatory
stimulus, especially of bacterial origin.
• It is therefore often classed as an acute phase reactant.
• In this case, it is produced mainly by the cells of the lung and the intestine
• It does not rise significantly with viral or non-infectious inflammations.
• With the derangements that a severe infection with an associated
systemic response brings, the blood levels of procalcitonin may rise to
100 µg/L.
• In serum, procalcitonin has a half-life of 25 to 30 hours. Remarkably the
high procalcitonin levels produced during infections are not followed by a
parallel increase in calcitonin or a decrease in serum calcium levels.
• The inhospital mortality approaches 30%
despite advances in critical care during the last
several decades.
• To date, the largest reductions in mortality
have been associated with early identification
of sepsis, initiation of a 3-hour care bundle
and rapid administration of broad-spectrum
antibiotics
• Sepsis remains a highly lethal entity resulting
in more than 200000 USA deaths per year7
and an in-hospital mortality upward of 30%
despite advances in critical care
Diagnostic Summary of Studies Investigating the Therapeutic Advantages of PCT