Serum procalcitonin in pregnancy-associated sepsis: A case control study

Abstract

Background. Procalcitonin (PCT) is an established marker for sepsis, particularly bacterial, but its use in diagnosing pregnancy-associated sepsis (PAS) is relatively unexplored. Objective. To investigate whether PCT could be used for the diagnosis of PAS in our study population, and what the appropriate values might be for the diagnosis. Methods. The study included 40 pregnant, post-abortal and postpartum women with PAS, identified using systemic inflammatory response syndrome criteria. Patients with hypertensive disorders, premature rupture of membranes, severe trauma, liver cirrhosis and lung or thyroid malignancies were excluded. Forty healthy term pregnant women with sterile urine cultures were taken as controls. PCT levels were obtained at admission and statistically compared between the groups. Severity and culture positivity in PAS were also assessed. Results. Severe PAS was present in 30 patients. Overall culture positivity was seen in 55% (n=22) of subjects. Culture-positive patients had higher PCT levels (3.03 µg/L) compared with the culture-negative (1.77 µ/L), though this did not reach statistical significance (p=0.235). Mean (standard deviation) PCT in PAS patients was 2.46 (0.56) µ/L, while in healthy controls it was 0.091 (0.019) µg/L. This difference was statistically significant (p<0.001). In severe PAS, PCT levels (3.12 (0.70) µg/L) were significantly higher than in non-severe (0.49 (0.21) µg/L). A cut-off of 0.125 µ/L gave the best diagnostic marker for PCT for PAS (sensitivity 67.5%; specificity 82.5%). Conclusion. PCT is raised significantly in PAS, especially in culture-positive situations. A PCT level >0.125 µg/L is suggested as the critical level for PAS diagnosis in appropriate clinical settings. Additionally, mean PCT levels differed significantly in severe v. non-severe PAS.