Inflammatory markers in patients with severe burn injury - What is the best indicator of sepsis?

Objective: To estimate the diagnostic value of serum PCT, CRP, leukocyte count and temperature as markers of sepsis in critically ill ICU burn patients. Design and setting: Prospective, observational study in a four bed Burn Intensive Care Unit. Patients: Forty-three patients admitted in a Burn ICU were included in our study. Measurements and results: Serum PCT, CRP concentrations, WCC (white cell count), neutrophils and temperature were measured within the first 24 h after-burn and daily thereafter. Severity of organ failure was estimated by sequential organ failure assessment (SOFA) score. Every day we classified all patients in one of the following three categories: non-systemic inflammatory condition (non-SIRS), SIRS non-infected and SIRS 2 infected or sepsis. Patients with infected SIRS differ significantly from non-infected SIRS in PCT (11.8 +/- 15.8 versus 0.63 +/- 0.0.43, respectively, p < 0.001). On the other hand, WCC, temperature and neurtophils did not differ significantly between patients with SIRS non-infected and infected SIRS. CRP was elevated in all three groups but didn't differ significantly between SIRS non-infected and septic patients. Area under receiver operating curves was 0.975 and showed reasonable discriminative power (p = 0.002, 95% CI, 0.91-1.035) in predicting of sepsis only for PCT. Conclusions: Serum procalcitonin levels can be used as an early indicator of septic comphimtion in patients with severe burn injury. (c) 2006 Elsevier Ltd and ISBI. All rights reserved.