Procalcitonin Clearance for Early Prediction of Survival in Critically Ill Patients with Severe Sepsis

Mohd Basri Mat Nor,Azrina Md Ralib

doi:10.1155/2014/819034

Abstract

Introduction. Serum procalcitonin (PCT) diagnosed sepsis in critically ill patients; however, its prediction for survival is not well established. We evaluated the prognostic value of dynamic changes of PCT in sepsis patients. Methods. A prospective observational study was conducted in adult ICU. Patients with systemic inflammatory response syndrome (SIRS) were recruited. Daily PCT were measured for 3 days. 48 h PCT clearance (PCTc-48) was defined as percentage of baseline PCT minus 48 h PCT over baseline PCT. Results. 95 SIRS patients were enrolled (67 sepsis and 28 noninfectious SIRS). 40% patients in the sepsis group died in hospital. Day 1-PCT was associated with diagnosis of sepsis (AUC 0.65 (95% CI, 0.55 to 0.76)) but was not predictive of mortality. In sepsis patients, PCTc-48 was associated with prediction of survival (AUC 0.69 (95% CI, 0.53 to 0.84)). Patients with PCTc-48 > 30% were independently associated with survival (HR 2.90 (95% CI 1.22 to 6.90)). Conclusions. PCTc-48 is associated with prediction of survival in critically ill patients with sepsis. This could assist clinicians in risk stratification; however, the small sample size, and a single-centre study, may limit the generalisability of the finding. This would benefit from replication in future multicentre study.

Highlights

Serum procalcitonin (PCT) diagnosed sepsis in critically ill patients; its prediction for survival is not well established
After adjusting for severity of illness and organ failure (SAPS II and Sequential Organ Failure Assessment (SOFA) scores), Group 2 remained independently associated with mortality (HR 2.90). In this prospective study of patients with systemic inflammatory response syndrome (SIRS), we demonstrated that serum PCT measured within 24 hours of Intensive care unit (ICU) admission was associated with diagnosis of sepsis; it was not predictive of mortality
We demonstrated that in patients with SIRS, PCT measured within 24 hours of ICU admission was associated with diagnosis of sepsis

Summary

Introduction

Serum procalcitonin (PCT) diagnosed sepsis in critically ill patients; its prediction for survival is not well established. We evaluated the prognostic value of dynamic changes of PCT in sepsis patients. Day 1-PCT was associated with diagnosis of sepsis (AUC 0.65 (95% CI, 0.55 to 0.76)) but was not predictive of mortality. PCTc-48 was associated with prediction of survival (AUC 0.69 (95% CI, 0.53 to 0.84)). Patients with PCTc-48 > 30% were independently associated with survival (HR 2.90 (95% CI 1.22 to 6.90)). PCTc-48 is associated with prediction of survival in critically ill patients with sepsis. This could assist clinicians in risk stratification; the small sample size, and a single-centre study, may limit the generalisability of the finding. Most studies have shown that it is not possible to predict the prognosis based on high levels of PCT [11,12,13,14]

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