Abstract
BackgroundProcalcitonin is useful for the diagnosis of sepsis but its prognostic value regarding mortality is unclear. This prospective observational study was designed to study the prognostic value of procalcitonin in prediction of 28 day mortality in patients of sepsis. Fifty-four consecutive patients of sepsis, severe sepsis and septic shock defined using the 2001 Consensus Conference SCCM/ESICM/ACCP/ATS/SIS criteria from medical Intensive Care Unit (ICU) of a tertiary care center in New Delhi, India were enrolled from July 2011 to June 2013. Procalcitonin (PCT), C-reactive protein (CRP) measurements were recorded on day 1, day 7 and day 28 of follow up.ResultsProcalcitonin value was a better predictor of all-cause short-term mortality than C-reactive protein. Those patients with Procalcitonin levels <7 ng/ml showed higher cumulative survival than those with level [greater than or equal to]7 ng/ml (69.1% vs. 39.5%, p = 0.02). No such effect was observed in relation to C-reactive protein. Procalcitonin levels [greater than or equal to]7 ng/ml predicted mortality with a hazard ratio of 2.6(1.1-6.3).ConclusionsA Procalcitonin value [greater than or equal to]7 ng/ml obtained at the time of admission to the ICU is a predictor of short-term mortality and thus may allow the identification of those septic patients at increased mortality risk, and help improve their treatment.
Highlights
Procalcitonin is useful for the diagnosis of sepsis but its prognostic value regarding mortality is unclear
Patients were critically ill with baseline mean Acute physiology and chronic health evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) and Simplified acute physiology score (SAPS) II scores of 24.7, 8.3 and 53.2, respectively
Respiratory tract was the source of sepsis in majority of cases (71%) followed by genitourinary tract (12%), skin and soft tissue (10%) and abdomen (9%)
Summary
Procalcitonin is useful for the diagnosis of sepsis but its prognostic value regarding mortality is unclear. Prompt diagnosis and administration of appropriate antimicrobial therapy are essential to reduce complications associated with sepsis-related organ failure. The early detection of patients with unfavourable prognosis or with an increased risk of mortality is essential in order to prevent consequent organ dysfunction, which would increase the degree of complications and patient mortality. Serum PCT levels have been observed to increase with increasing severity of sepsis and organ dysfunction [5]. Administration of PCT to septic animals increases their risk of mortality [6] implying a relationship between high serum PCT and death. PCT levels may contribute to earlier and better stratification of ICU patients at the risk of death; the correlation between the level of PCT and the prognosis of sepsis is unclear
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