THE ROLE OF PROCALCITONIN AS A DIAGNOSTIC MARKER OF BACTERIAL SEPSIS IN BURNS.

BACKGROUND: Patients with burn wounds are at high risk of infection. Since sepsis contributes significantly to morbidity and mortality, early diagnosis is essential. Procalcitonin (PCT) is a biomarker released in response to inflammation and specifically bacterial infection. It may therefore be a useful biomarker for sepsis in burns.

METHOD: All adult patients admitted to two Burns Intensive Care Units in Johannesburg were included in a retrospective data review. Data from the preceding three years related to demographics and sepsis were collated.

RESULTS: Records of 178 patients were reviewed. Young black males are most commonly admitted with no significant difference between the public and private sector. The most significant risk factor for sepsis is percentage total body surface area burned (p = 0.012). Significantly more infections occurred in public-sector patients with the public sector treating a greater percentage of patients with more severe burns (92.9 vs. 57.9, p = 0.001). A rise in PCT is a significant biomarker for bacterial infection early after a burn (p = 0.03) but not after day eight. PCT shows correlation with CRP as a biomarker for sepsis (p < 0.001), but not with other biomarkers. Patients who were on inotropes also had a significantly increased PCT level (p = 0.0001).

CONCLUSION: While there is some evidence to suggest that PCT may be useful as an adjunct biomarker of infection in burn patients, this evidence is limited and insufficient to change current clinical guidelines.