Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 111503

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : OC20 - OC23 Full Version

Serum Procalcitonin Correlation with Sepsis Severity and Patient Outcomes: An Observational Study

Published: November 1, 2022 | DOI:
Sirisha Jujjuru, Gautam Panduranga, Shivaraju Kanugula

1. Resident, Department of Internal Medicine, Krishna Institute of Medical Sciences and Hospitals, Hyderabad, Telangana, India. 2. Associate Professor, Department of General Medicine, Mediciti Institute of Medical Sciences, Hyderabad, Telangana, India. 3. Consultant, Department of Internal Medicine, Krishna Institute of Medical Sciences and Hospitals, Hyderabad, Telangana, India.

Correspondence Address :
Dr. Gautam Panduranga,
B115, Mayflower Heights, Mallapur, Hyderabad, Telangana, India.


Introduction: Sepsis is a life-threatening condition of human body. It is caused by improper response of host immune system to various infective conditions. Procalcitonin (PCT) has been a promising biomarker for aiding early diagnosis, risk stratification and treatment in patients with sepsis and septic shock.

Aim: To study correlation of serial serum procalcitonin (day 1, 3 and 7) with severity of sepsis and patient outcomes (in-hospital stay or mortality).

Materials and Methods: The study was a descriptive, observational study conducted at Krishna Institute of Medical Sciences, Secunderabad, Telangana, India, on 100 patients admitted to Medical Intensive Care Unit (MICU), both males and females of age more than 18 years, with sepsis or septic shock, from August 2019 to January 2021. Serum procalcitonin was measured by BRAHMS PCT-Q immunochromatographic assay using a commercially available test kit. Blood, urine and wound cultures were performed to confirm specific infection. The Chi-square test, Fischer’s-exact test and Pearson correlation tests were used to calculate association and correlations amongst qualitative data.

Results: Total 100 patients (mean age was 49.9±17.0 years; 62 males and 38 females) were included in the study. A total of 74 patients were observed to be have sepsis and 26 patients had septic shock. Mortality was 36%. There was a positive correlation with Sequential Organ Failure Assessment (SOFA) score on day 1 and 3, but not day 7. PCT was high in 85% of patients on admission (day 1). Higher levels of PCT was observed both in patients with sepsis (82.4%) and septic shock (92.3%), suggesting that it is a good diagnostic marker in these patients. Mean PCT was higher in death patients compared to discharged patients on day 1,3 and 7 (p-value <0.05). Majority of patients (71.8%) with higher PCT on admission stayed in ICU for less than 5 days, whereas over half (53.3%) with normal PCT had a short ICU stay (p-value=0.18).

Conclusion: Procalcitonin is a useful marker for early diagnosis of sepsis and septic shock and also severity of infection on admission to ICU. High procalcitonin also predicts mortality and can be a useful tool for rational use of antibiotics in patients admitted to ICU.


Biomarkers, Mortality, Risk stratification, Septic shock, Sequential organ failure assessment score

Sepsis is a life-threatening condition of human body. It is caused by improper response of host immune system to various infective conditions (1). Timely diagnosis as well as timely management of septic condition with specific antibiotics is very essential during first few hours of the triage (2). The reckless and non specific uses of antibiotics for every ailment leads to vigorous rise in opportunistic infection as well as resistance, thus increasing chances of more mortality and the healthcare costs (3),(4). Better and timely diagnosis of causative agent and proper antibiotic therapy has a great future in solving this problem (5).

The use of blood biomarkers can help a lot in future to diagnose and improve septic conditions (6). In order to improve patient care, the biomarkers need to complement clinical signs as well as other tests for diagnosis and prognosis of the patients. Clinical management of critically ill patients with severe infection and sepsis can be improved by shortening the time to diagnostic and treatment decision (i.e., differentiation of bacterial from other etiologies, including viral, fungal and non infectious) (7).

Early diagnosis and prompt antimicrobial therapy is crucial in the treatment of sepsis for saving lives. Sepsis is a Systemic Inflammatory Response Syndrome (SIRS) that affect all organs. Scientific advancements in molecular biology has helped us to identify relevant biomarkers for early diagnosis of sepsis (8). WBC, C-Reactive Protein (CRP) and Interleukin-1 (IL-1) are the conventional markers used for diagnosis of sepsis. Compared to CRP, Procalcitonin (PCT) has better diagnostic and prognostic value and will clearly distinguish viral and bacterial meningitis (9),(10). Blood culture is considered as the gold standard for the confirmation of bacteraemia and can isolate and identify the causative agent, but there is time delay, therefore a quick testing of a biomarker is extremely useful for early diagnosis of sepsis (11).

Best prognostic information is derived from serial procalcitonin levels. Decreasing levels are found in patients responding to therapy. Increasing level may indicate treatment failure. Drop of PCT to at least 80-90% from its peak values are reasonable threshold for deescalating antibiotic therapy. PCT alone or in combination with other biomarkers would serve as a promising tool for understanding the prediction, cause, diagnosis, progression, regression and outcome of the treatment regimes. Hence, the present study was planned with the aim to study the role of serum PCT and its correlation with severity of sepsis and in-hospital outcomes (in-hospital stay or mortality).

Material and Methods

This descriptive observational study was conducted in Medical Intensive Care Unit, Krishna Institute of Medical Sciences (KIMS), Secunderabad, Telangana, India, from August 2019 to January 2021, among 100 patients.

Sample size calculation: Simple random sampling method was used in the present study subjects after obtaining Ethics Committee approval from KIMS hospitals (Approval no. KIMS/EC/2019/40-06). The sample size was calculated as per formula given by World Health Organisation (12):


Where, d=Absolute precision (value< P) (0.124); P=guess of Population (any value <1)=0.625; Z=Z value associated with confidence (2.578) (13); N=minimum sample size=100.

Inclusion criteria: Patients both male and female with age more than 18 years, admitted with clinical criteria for sepsis and septic shock in medical intensive care unit and gave consent for performing the investigation were included in the study.

Exclusion criteria: Patients with age less than 18 years of age, who could not either afford or not willing to undergo the investigation and are already vigorously treated with antibiotics outside were excluded from the study.

Study Procedure

Demographic data, history, clinical examinations and details of basic investigations was recorded in a prestructured proforma for all included study participants. Serum procalcitonin was measured by immunochromatographic assay using a commercially available test kit and interpreted as per manufacturers recommendations.

i) PCT >10 ng/mL: Severe bacterial sepsis or septic shock.
ii) PCT 2-10 ng/mL: Severe systemic inflammatory response, most likely due to sepsis unless other causes are known.
iii) PCT 0.5-2 ng/mL: A systemic infection cannot be excluded.
iv) PCT <0.5 ng/mL: Local bacterial infection possible; sepsis unlikely.

Blood culture to determine bacteraemia was performed. Culture of wound discharge to know local infection was done. The BRAHMS PCT-Q, an immunochromatographic test for the semi-quantitative detection of procalcitonin, which is used for diagnosing and controlling the treatment of severe, bacterial infection and sepsis (14). The colour intensity of the band is directly proportional to the PCT concentration of the sample.

Statistical Analysis

Data collected was entered in Microsoft (MS) excel sheet and analysed by using Statistical Package for Social Sciences (SPSS) version 24.0 International Business Management (IBM) United States of America (USA). Qualitative data was expressed in terms of proportions. Quantitative data was expressed in terms of Mean and Standard deviation. Association between two qualitative variables was seen by using Chi-square/Fischer’s-exact test. Pearson correlation test was used to find correlations amongst the qualitative variables.


Total of 100 patients were included and analysed. Mean age was 49.9±17.0 years. Majority of the patients were from 51-60 years age group i.e, 24 and majority of the cases were males i.e, 62. A total of 74 patients were in sepsis and 26 were in septic shock. (Table/Fig 1) showed distribution of patients according to their demographic details and clinical diagnosis.

At the time of presentation, the relevant investigations were done. Mean C-Reactive Protein (CRP) was 25.2±16.7 mg/L, mean serum Glutamic Pyruvic Transaminase (SGPT) 131.6±267.5 units/L of serum, mean serum Glutamic-oxaloacetic Transaminase (SGOT) was 180.5±497.6 U/L, mean serum creatinine was 2.3±3.7 mg/dL, mean SOFA score was 2.2±0.4 and stay in Intensive Care Unit (ICU) was 5.2±3.5 days for all included subjects. Positive blood culture was present in 23 cases, urine culture in 24 cases, sputum culture was present in 15 cases (Table/Fig 2). Majority of the patients i.e., 69 cases required less than five days of ICU stay, 22 stayed in ICU for 6-10 days and remaining nine patients required 11-15 days of ICU admission (Table/Fig 2).

Out of 100 cases of sepsis, 36 deaths occurred and 64 survived. So, the mortality rate in this study was 36% (Table/Fig 3).

Serum PCT assessment was done on the day 1, on day 3 and day 7. It showed positive correlation between serum PCT at day 1 with patientsSOFA score. Positive correlation was also seen on day 3 but not on day 7 (Table/Fig 4).

Mean PCT at day 1 of admission in death patients was 38.63±31.82 ng/mL and that of discharged patients was 22.58±19.83 ng/mL i.e. statistically significant difference between the PCT values at day 1 of admission was observed (p-value <0.05). Mean PCT on 3rd day of admission in death patients was 39.34±26.31 ng/mL and that of discharged patients was 17.3±20.73 ng/mL i.e. statistically significant difference was seen between the PCT values at 3rd day of admission. Mean PCT on 7th day of admission in death patients was 52.4±33.24 ng/mL and that of discharged patients was 5.67±7.35 ng/mL i.e. statistically significant difference was observed between the PCT values at 7th day of admission (Table/Fig 5). This suggests a positive correlation between high PCT values and mortality.

However, when the death rate was compared with respect to high and normal PCT groups, the difference was found to be statistically non significant (p-value=0.89) (Table/Fig 6).

There was a positive correlation higher PCT values and diagnosis of sepsis and septic shock and this was found to be to be statistically significant (p-value<0.05). It means both in sepsis and septic shock patients, PCT was significantly elevated. So, PCT is a good and early diagnostic marker of sepsis and septic shock (Table/Fig 6). Out of 85 cases with high PCT value, 71.8% had ICU stay of less than 5 days as compared to 53.3% cases with normal PCT. Out of 85 cases with high PCT value, 18.8% had ICU stay of 6-10 days as compared to 40 % cases with normal PCT. Out of 85 cases with high PCT value, 9.4 % had ICU stay of 11-15 days as compared to 6.7 % cases with normal PCT. This association was found to be non significant (Table/Fig 6).


The previous study of Sinha M et al., included 40 patients from ages ranged 18-84 years with male: female ratio, 2.33:1 (15). Similarly studies of Martin GS et al., and Todi S et al., reported sepsis to be more prevalent in males (16),(17). Khan AA et al., conducted the study with the objective to assess the diagnostic and prognostic value of PCT in sepsis. Out of total 60 patients, 32 (53.34%) were male and 28 (46.66) were female. A 18 (30%) male and 14 (23.33%) female patients were <50 years of age (13).

The mean PCT in the present study when compared between two groups, it was observed that there was statistically significant difference between the PCT values at day 1, day 3 and day 7. It means PCT was significantly higher in death patients as compared to discharged patients (p-value <0.05). Sinha M. et al., found in his study that one patient amongst 12 patients with PCT greater than 10 ng/mL did not have any signs of sepsis or infection and recovered with inotropic support (15). Khan AA et al., observed that in 63.33% cases, serum PCT was elevated (13). They also found significant difference in mortality in patients with raised serum procalcitonin versus normal serum procalcitonin level. The findings are almost consistent with the present study results. This also correlates with the studies by Assicot M et al., and Rey C et al., that serum procalcitonin level is raised in the patients with septicaemia (18),(19).

Many previous studies had demonstrated raised serum PCT levels in patients with septic condition and correlated them with the outcome of the disease. PCT can be used for specific diagnosis, and follow-up of ICU patients (20). Serum PCT levels have been noted to increase with increasing severity of sepsis and indicates that better source control is required (21). Present study also revealed that every day charting the PCT value is used for monitoring the host response to the infection and the antibiotic treatment.

Biomarkers are expected to provide better information about presence of a relevant bacterial infection, its severity and treatment response, with early and rapid recognition to provide high diagnostic accuracy. PCT as a biomarker fits in many of these criterias and has depicted high diagnostic accuracy for septic condition of the patients (22). Hence, for assessment of patients with sepsis must include proper use of PCT for early and specific diagnosis and treatment of patients (23). The present study used immunochromatographic test for the semi-quantitative detection of PCT while most other studies used immunoluminometric method and were able to achieve high sensitivity and modest specificity with a cut-off of 1-1.2 ng/mL (18),(19),(20),(21).


Small sample size was a limitation for the present study.


Higher levels of procalcitonin level had a positive correlation with severity of sepsis on admission to ICU (on day 1 and 3). Higher levels were also seen in most patients with sepsis and septic shock, suggesting that it’s a good and early diagnostic biomarker. There was also a positive correlation with mortality in these patients. Measurement of serial procalcitonin values is therefore useful for management decisions in these patients, including rational use of antibiotics. It helps in risk stratification and aggressive line of treatment can be followed in patients with higher procalcitonin, which is predictive of higher severity and higher mortality risk.


Bracht H, Hafner S, Weiss M. Sepsis Update: Definition and Epidemiology. Anasthesiol Intensiv med Notfallmed Schmerzther. 2019;54(1):10-20. [crossref] [PubMed]
Rhodes A, Evans LE, Alhazzani W, Mitchell ML, Massimo A, Richard F, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-77. 10.1007/s00134-017-4683-6.
Zilahi G, McMahon MA, Povoa P, Loeches IM. Duration of antibiotic therapy in the intensive care unit. J Thorac Dis. 2016;8(12):3774-80. [crossref] [PubMed]
Jee Y, Carlson J, Rafai E, Musonda K, Huong TTG, Daza P, et al. Antimicrobial resistance: A threat to global health. Lancet Infect Dis. 2018;18(9):939-40. [crossref] [PubMed]
Fridkin S, Baggs J, Fagan R, Magill S, Pollack LA, Malpeidi P, et al. Vital signs: Improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep. 2014;63(9):194-200.
Schuetz P, Aujesky D, Muller C, Muller B. Biomarker-guided personalised emergency medicine for all- hope for another hype? Swiss Med Wkly. 2015;145:w14079. Doi: [crossref]
Schuetz P, Raad I, Amin DN. Using procalcitonin-guided algorithms to improve antimicrobial therapy in ICU patients with respiratory infections and sepsis. Curr Opin Crit Care. 2013;19(5):453-60. [crossref] [PubMed]
Sakr Y, Burgett U, Nacul FE, Reinhart K, Brunkhorst F. Lipopolysaccharide binding protein in a surgical intensive care unit: A marker of sepsis? Crit Care Med. 2008;36(7):2014-22. [crossref] [PubMed]
Usama MA, Nermin AA, Ayman AAE, Sultan MH. Serum procalcitonin in viral and bacterial meningitis. J Glob Infect Dis. 2011;3(1):14-18. [crossref] [PubMed]
Hina C, Juhua Z, Yin Z, Mir MA, Franklin M, Prakash SN, et al. Role of cytokines as a double-edged sword in sepsis. In Vivo. 2013;27(6):669-84.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States. Analysis of incidence, outcome and associated cost of care. Crit Care Med. 2001;29(7):1303-10. [crossref] [PubMed]
Lwanga SK, Lameshaw S. Sample size determination in health studies. WHO, Geneva, 1991.;jsessionid=286BF8CD57AA16EBBD38800BF1712FFC?sequence=1.
Khan AA, Singh R, Singh PK. Diagnostic and prognostic significance of procalcitonin in septicemia. Int J Adv Med. 2017;4(3):630-34. [crossref]
Thermo Scientific B•R•A•H•M•S PCT-Q: Immunochromatographic point-of-care test for the determination of PCT (Procalcitonin) in serum and plasma;
Sinha M, Desai S, Mantri S, Kulkarni A. Procalcitonin as an adjunctive biomarker in sepsis. Indian J Anaesth. 2011;55(3):266-70. [crossref] [PubMed]
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348(16):1546-54. [crossref] [PubMed]
Todi S, Chatterjee S, Bhattacharyya M. Epidemiology of severe sepsis in India. Crit Care Med. 2007;11(suppl. 2):P65. [crossref] [PubMed]
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;347(8844):515-18. [crossref] [PubMed]
Rey C, Arcos ML, Coneha A, Mendina A. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intens Care Med. 2007;33(3):477-84. [crossref] [PubMed]
Afsar I, Sener AG. Is procalcitonin a diagnostic and/or prognostic marker in sepsis? Infectious Diseases in Clinical Practice. 2015;23:03-06. Doi: 10.1186/s40560-017- 0246-8. [crossref]
Kibe S, Adams K, Barlow G. Diagnostic and prognostic biomarkers of sepsis in critical care. J Antimicrob Chemother. 2011;66 (2):33-40. [crossref] [PubMed]
Schuetz P, Chiappa V, Briel M, Greenwald JL. Procalcitonin algorithms for antibiotic therapy decisions: A systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med. 2011;171(15):1322-31. [crossref] [PubMed]
Hur M, Kim H, Lee S, Cristofano F, Magrini L, Marino R, et al. Diagnostic and prognostic utilities of multimarkers approach using procalcitonin, B-type natriuretic peptide, and neutrophil gelatinase-associated lipocalin in critically ill patients with suspected sepsis. BMC Infect Dis. 2014;14:224. Doi: 10.1186/1471-2334-14-224. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/60163.17128

Date of Submission: Sep 14, 2022
Date of Peer Review: Oct 11, 2022
Date of Acceptance: Oct 31, 2022
Date of Publishing: Nov 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 27, 2022
• Manual Googling: Oct 10, 2022
• iThenticate Software: Oct 25, 2022 (23%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)