Abstract
ObjectiveTo determinate the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) changes during the first two days of admission to the ICU with sepsis and/or septic shock, and to compare it with changes in Acute Physiology And Chronic Health Evaluation II (APACHE-II) and Sepsis-related Organ Failure Assessment (SOFA) prognostic scores.MethodsA single-center prospective observational study was performed. Fifty consecutive patients admitted to the ICU, diagnosed of severe sepsis/septic shock were included. We considered risk factors for infection: diabetes mellitus, chronic obstructive pulmonary disease (COPD), previous antibiotic treatment, central intravascular catheter, bladder catheter, active neoplasia.ResultsMedian aged 67(52-75) years with median APACHE-II 19(14-25) points and SOFA scores 7(5-11) points on admission, and 28-day mortality of 42%. When we studied the relationship between mortality and the changes between the day of admission and the second day of the variables studied, we found that APACHE-II (p = 0.001) and SOFA (p = 0.002) between admission and second day raised significantly in no survivors, with no significant changes in CRP and PCT. Multivariate analysis showed that mortality was significantly associated to changes in SOFA score (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.18-3.86) and to the presence of one or more risk factors for infection (OR, 6.01; 95% CI, 1.01-35.78) but not with PCT changes. Mortality was also related to the variations between the day of admission and the fifth day on APACHE-II (p = 0.002), SOFA (p < 0.001) and PCT (p = 0.012).ConclusionsChanges in SOFA and APACHE-II scores between admission and second day in ICU septic patients are more sensitive mortality predictors than the observed changes in CRP and PCT values. Changes in PCT levels between the day of ICU admission and the fifth day are significantly related to mortality and may be useful as an additional marker in patient outcome.
Highlights
Mortality related to sepsis and septic shock continues to be high in the medical literature despite advances in early diagnosis and appropriate treatment
When we studied the relationship between mortality and the changes between the day of admission and the second day of the variables studied, we found that APACHE-II (p = 0.001) and Sepsis-related Organ Failure Assessment (SOFA) (p = 0.002) between admission and second day raised significantly in no survivors, with no significant changes in C-reactive protein (CRP) and PCT
Multivariate analysis showed that mortality was significantly associated to changes in SOFA score and to the presence of one or more risk factors for infection (OR, 6.01; 95% CI, 1.01-35.78) but not with PCT changes
Summary
Mortality related to sepsis and septic shock continues to be high in the medical literature despite advances in early diagnosis and appropriate treatment. Sepsis biomarkers are molecules that support the diagnosis of a septic condition, being used as prognostic and follow-up indicators as well [2]. They have been used as a guide for the detection of complications in patients with acute severe dyspnea [3]. Among these biomarkers, procalcitonin (PCT) and C-reactive protein (CRP) are the most commonly used ones.
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