Prognostic value of procalcitonin clearance rate and sequential organ failure assessment score in septic shock children

Abstract

Objective To assess the disease severity and prognosis value by observing the kinetic change of serum procalcitonin(PCT), PCT clearance rate(PCT-C) and Δsequential organ failure assessment(ΔSOFA) score in the patients with septic shock. Methods A single-center observational study was conducted.A total of 274 patients with septic shock admitted into intensive care unit of Hunan Province Children′s Hospital from July 2013 to December 2015 were enrolled.The patients were divided into survival group(n=178) and nonsurvival group(n=96)according to the therapeutic outcome on day 28.The PCT and SOFA scores were estimated within 24 hours when septic shock was diagnosed.PCT-C and ΔSOFA were examined on day 2, day 3, day 5, day 7, day 9 after the septic shock was diagnosed.The diagnostic and predictive performance of PCT, PCT-C and ΔSOFA score were assessed by the receiver operating characteristic curve(ROC). Results There were no statistical differences on serum concentrations of PCT at 24 hour, 48 hour, 72 hour between two groups.But PCT-C in survival group on day 2, day 3, day 5, day 7, day 9 were significant higher than those of nonsurvival group.The area under the ROC curve were 0.800(95%CI 0.69~0.91, P=0.000)for PCT-C on day 9, 0.980(95%CI 0.78~0.95, P<0.000)for ΔSOFA on day 9 and 0.779(95%CI 0.66~0.89, P<0.001)for SOFA score when septic shock was diagnosed.A ROC analysis identified a PCT-C on day 9 more than 38.98%(sensitivity: 78.90%, specificity: 66.80%) as the most accurate cut-off in predicting death.A ROC analysis identified ΔSOFA score on day 9 less than -0.5(sensitivity: 89.10%, specificity: 91.50%) as the most accurate cut-off in predicting death. Conclusion The increased levels of PCT in patients with septic shock were associated with the poor control of infection and may indicate the deterioration of septic shock, it also can reflect the activity of infection in time.Keeping observing the dynamic change of PCT and analyzing PCT-C are more useful.The PCT-C levels and ΔSOFA score may provide evidence of disease progression and be helpful in risk stratification in patients with septic shock, and lower level of PCT-C and ΔSOFA score may accompany serious infection and predict poor prognosis. Key words: Procalcitonin; Procalcitonin clearance rate; Septic shock; Sequential organ failure assessment,