Valor predictivo de la procalcitonina en respuesta al uso de antibiótico en los pacientes sépticos ingresados en la UCIP del Hospital Dr. Roberto Gilbert Elizalde en el periodo de enero a junio del 2016.

Abstract

Background: procalcitonin is a very sensitive and specific biomarker for the diagnosis and prognosis of sepsis. It has also been shown to be useful as a follow up to antimicrobial management. In this respect, there are not so many studies in the pediatric area. said practice in order to establish the variation of procalcitonin as a marker of control in the antimicrobial response. Materials and Methods: The following is an observational, retrospective, analytical study of the kinetics of procalcitonin in patients admitted with a diagnosis of sepsis in the pediatric intensive care area of the Dr. Roberto Gilbert Elizalde hospital in the period from January to June. 2016, the entry into the area of procalcitonin will be taken as a reference and compared to the next one after initiating antimicrobial treatment, observing the percentage of decrease of procalcitonin related to the clinical behavior of the patient and their need for subsequent antimicrobial rotation or the conclusion of the initial treatment, values of procalcitonin ranging from less than 2 ng / ml, from 2 to 10 ng / ml, 10-30 ng / ml, greater than 30 ng / ml and the percentage of decrease in levels related to time. Results: 60 patients with a diagnosis of sepsis were taken from January to June of 2016, 8 of whom had to leave the study because they did not meet inclusion c riteria, so we analyzed 52 children aged between 1 month and 17 years, where children predominated younger than 2 years with an average age of 1 year, were more male patients with a ratio of 1/1.7 on the female, the most frequently diagnosed pathology as the focus of the infectious was pneumonia 32% followed by sepsis without an obvious focus at the time of income 27%. Regarding procalcitonin, the values of admission were found to be 62% above 2ng / ml, while 38% was between 0.5 and 2 ng / ml. The kinetics of procalcitonin were seen both in ascent (38%) and in decrease (56%) of serum values in relation to the control of admission to the UCIP , the time required for its variation was between 2 to 5 days with an average of 3 days, the percentage that decreased their levels was between 20% and 100%, observing that 38% of patients who experienced decrease of procalcitonin levels in relation to the income this was greater than 50% of the value of procalcitonin. The days of admission of these patients were between 5 and 10 days, observing that there is a relationship between the values accounted for by procalcitonin and the longer time of hospitalization. The days of antibiotic therapy were between 2 and 21 days observing only the first regimen administered, an average of 7 days and its rotation was multifactorial related to the clinical status of the patient. Mortality was found to be 48%, which was found to be related to increased levels of procalcitonin. Statistical significance (p 0. 01) was observed for the reduction of procalcitonin following the use of antibiotics in patients who survived sepsis. Conclusions: monitoring of antibiotic therapy with variation of procalcitonin levels is a useful test because it tends to increase in response to poor response and decreases more than 50% of its initial value when there is a good response, however, it is considered that the decision of antibiotic rotation could remain multifactorial.