Clinical significance of dynamic monitoring of procalcitonin in guiding the use of antibiotics in patients with sepsis in ICU

Abstract

To investigate the significance of dynamic monitoring of procalcitonin (PCT) in guiding the use of antibiotics for treating patients with sepsis in intensive care unit (ICU). Eighty-two patients with sepsis from January 2012 to June 2013 hospitalized in ICU of First Hospital of Jilin University were enrolled, and they were randomly divided into regular antibiotic therapy group (RAT group, n=40) and PCT monitoring in guiding the use of antibiotics group (PCT group, n=42). Patients in RAT group were treated according to principle of antibiotics usage, while in PCT group patients' PCT value was observed everyday. When no active symptoms of infection were shown, and acute physiology and chronic health evaluation II (APACHEII) scores declined, PCT value decreased over 90% or PCT value lower than 0.25 μg/L time point were selected as drug withdrawal indication. The general status of the patient, antimicrobial drug use time, and prognosis were compared between the two groups, and Kaplan-Meier method was used for survival curve analysis. Variance analysis was used for repeating measurement to observe dynamic serum PCT level of the two groups of patients for survival and death during 7 days. Mann-Whitney U test or χ(2) test showed that there were no statistical significance in age, gender, APACHEII score, blood culture positive rate, sputum culture positive rate, cardiac insufficiency, renal failure, respiratory failure, and ventilator and hemofiltration usage (all P>0.05). Log Rank test results showed that the time of antimicrobial drug usage was significantly reduced in PCT group than that in RAT group [days: 8.1±0.3, 95% confidence interval (95%CI 8.3-9.7) vs. 9.3±0.3 (95%CI 8.7-10.1), P=0.013]. Kaplan-Meier univariate survival curves showed that the speed of curve declination in PCT group was faster significantly than that in RAT group, suggesting that the time of using antimicrobial drug was shortened. There was no significant difference in length of hospital stay, ICU stay time, number of death in 28 days, number of cases of recurrence in 28 days and clinical cure rate between two groups (all P>0.05). PCT level in non-survivors in both groups was significantly higher than that in the survivors, exceeding more than 10 μg/L in the early and late stages of treatment. Dynamic monitoring of PCT can effectively reduce antimicrobial drug use in ICU patients with sepsis, but there is no significant difference in patients' prognosis.