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Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 19 / No. 2 / Published : 2013-01

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Original Article :

Procalcitonin and interleukin-6 in sepsis systemic inflammatory response syndrome (sirs)

Author :

  1. Indranila KS*1
  2. Tjahjati DM*2
  3. Emma*3
  1. Bagian Patologi Klinik Fakultas Kedokteran Universitas Diponegoro RSUP Dr. Kariadi Semarang
  2. Bagian Patologi Klinik Fakultas Kedokteran Universitas Diponegoro RSUP Dr. Kariadi Semarang
  3. Bagian Patologi Klinik Fakultas Kedokteran Universitas Diponegoro RSUP Dr. Kariadi Semarang

Abstract :

Sepsis is the cause of patient’s death in the intensive care unit. Sepsis is an inflammatory response to infections. Infection when continued can cause systemic inflammatory response syndrome (SIRS). Clinical signs and pathology of SIRS are similar to sepsis, thus clinical as well as  laboratory examination is needed to distinguish these. Culture result usually can be seen at least 24 hours after sampling. In this case a test is needed to diagnose sepsis quickly so that  the patient does not experience more severe conditions. The indicator used in the diagnostic procedure is to know the diagnostic value of procalcitonin (PCT) levels as well as of interleukin-6 (IL-6) for the diagnosis of sepsis. Thirty-two blood samples of patients treated in the Department of SIRS. Dr. Kariadi Semarang were taken consecutively  from November 2011 up to January 2012. PCT levels are determined by ELFA, levels of IL-6 were determined by ELISA method. To determine the sensitivity, specificity, positive predictive value and negative predictive value, 2x2 table was used. The ROC curve (receiver operating characteristic) showed an area under the curve of PCT of 0.83 (95% CI = 0.66 to 0.99), cut-off 5.1ng/mL was used as an indicator of sepsis. PCT diagnostic test results showed 88.9% sensitivity, 73.9% specificity, 57.1% positive predictive value and negative predictive value of 94.4%. The area under the curve for IL-6 was 0.67 (95% CI = 0.47 to 0.86), cut off 47.2 pg/mL as an indicator of sepsis. Diagnostic tests results showed 77.8% sensitivity, 60.9% specificity, 43.7% positive predictive value and negative predictive value of 87.5%. It can be concluded that the examination of serum PCT levels can be used as a diagnostic test (screening test) for sepsis.     Sepsis adalah penyebab kematian penderita di ruang Perawatan Intensif. Sepsis   merupakan respons inflamasi terhadap infeksi. Infeksi berlanjut menyebabkan Systemic inflammatory response syndrome (SIRS). Gambaran klinik dan patologis SIRS mirip sepsis,  sehingga diperlukan pemeriksaan klinik dan laboratorik untuk membedakannya. Kultur yang digunakan baru dapat diketahui paling sedikit 24 jam setelah pengambilan sampel. Perlu ada pemeriksaan untuk mendiagnosis sepsis dengan cepat agar penderita tidak jatuh ke keadaan yang lebih berat. Petunjuk yang digunakan adalah procalcitonin (PCT) dan interleukin 6 (IL-6).  Tujuan penelitian ini adalah untuk mengetahui nilai diagnostik kadar PCT dan IL-6 untuk diagnosis sepsis, yaitu dengan cara mengambil 32 sampel darah penderita SIRS yang dirawat di RSUP. Dr. Kariadi Semarang secara berurutan selama bulan November-Januari 2012. Kadar PCT ditentukan dengan metode ELFA, kadar IL-6  ditentukan dengan metode ELISA. Tabel 2x2 untuk menentukan kepekaan, kekhasan, nilai duga positif dan negatif. Dengan kurva ROC (receiver operating characteristic) didapatkan luas area di bawah kurva PCT adalah 0,83 (95% CI = 0,66 – 0,99), cut off 5,1 ng/mL sebagai petunjuk ada petunjuk sepsis. Hasil uji diagnostik PCT menunjukkan kepekaan 88,9%, kekhasan 73,9%, nilai duga positif 57,1% dan yang negatif 94,4%. Luas area di bawah kurva untuk IL-6 adalah 0,67 (95% CI = 0,47 - 0,86), cut off 47,2 pg/mL sebagai petunjuk sepsis. Hasil uji diagnostik menunjukkan kepekaan 77,8%, kekhasan 60,9%, nilai duga positif 43,7% dan yang negatif 87,5%. Pemeriksaan kadar serum PCT dapat digunakan untuk uji diagnostik (uji saring) sepsis.

Keyword :

SIRS, sepsis, PCT levels, , the levels of IL-6, culture,


References :

  1. Prihatini B, (2006). Diagnosis sepsis menggunakan procalcitonin. Surabaya : Indo J Clin Path Med Lab
  2. Decker T, (2004). Sepsis: avoiding its deadly toll. USA : J Clin Invest
  3. 3. NeSmith EG, Weinrich SP, Andrews JO, Medeiros RS, Hawkins ML, Weinrich M, (2009). Systemic inflammatory response syndrome score and race as predictors of length of stay in the intensive care unit. USA : Am J Crit Care
  4. Guntur HA, (2006). Penyakit tropik dan infeksi: sepsis. Jakarta : Pusat Penerbitan Departemen Ilmu Penyakit Dalam FKUI
  5. 5. Villar J, Maca-Meyer N, Perez-Mendez L, Flores C, (2004). Bench-to-bedside review: understanding genetic predisposition to sepsis. USA : Crit Care


   


Archive Article

Cover Media Content

Volume : 19 / No. : 2 / Pub. : 2013-01
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  6. Katekin from green tea leaves (camellia sinensis) to malondialdehyde (mda) and super oxide dismutase (sod)
  7. Procalcitonin and interleukin-6 in sepsis systemic inflammatory response syndrome (sirs)
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