Höhergradige Dekubitalulzera und Sepsis im Umfeld der Sterbephase

According to clinical data, decubitus ulcers are a source of bacteremia and sepsis in up to 50% of cases and are associated with a significant mortality. The aim of this prospective autopsy study was to investigate the frequency of sepsis at the time of death in elderly, multimorbid individuals with high-grade decubitus ulcers. Therefore, 99 autopsy cases were classified into 3 study groups (decubitus group, n=23; sepsis group, n=31; control group, n=45) and the sepsis marker procalcitonin (PCT) was determined. Procalcitonin is used in living patients as an inflammatory parameter to diagnose systemic bacterial infections and is also qualified for routine use in post-mortem sepsis diagnostics. In 21 cases of the decubitus group, PCT was below the reference value of 0.3 µg/l. In two cases that showed an increased PCT level, infectious diseases (inflammation of the renal pelvis, infection with methicillin-resistant staphylococcus aureus) were present at the time of death that accounted for the elevated PCT level. In the control group, PCT values were below the reference value of 0.3 µg/l in 84.5% of cases. On the contrary, PCT was increased in the sepsis group in all 31 cases. According to our results, the clinical opinion that patients with high-grade decubitus ulcers develop sepsis in up to 51% of cases is not correct.