Abstract
Procalcitonin (PCT) is a a marker of bacterial infection. Its prognostic role in the critically-ill patient, however, is still object of debate. Aim of this study was to evaluate the capacity of admission PCT (aPCT) in assessing the prognosis of the critically-ill patient regardless the presence of bacterial infection. A single-cohort, single-center retrospective study was performed evaluating critically-ill patients admitted to a stepdown care unit. Age, sex, Simplified Acute Physiology Score II (SAPS-II), shock, troponin-I, aPCT, serum creatinine, cultures and clinical endpoints (in-hospital mortality or Intensive Care Unit (ICU) transfer) were collected. Time free from adverse event (TF-AE) was defined as the time between hospitalization and occurrence of one of the clinical endpoints, and calculated with Kaplan-Meier curves. We engineered a new predictive model (POCS) adopting aPCT, age and shock.We enrolled 1063 subjects: 450 reached the composite outcome of death or ICU transfer. aPCT was significantly higher in this group, where it predicted TF-AE both in septic and non-septic patients. aPCT and POCS showed a good prognostic performance in the whole sample, both in septic and non-septic patients. aPCT showed a good prognostic accuracy, adding informations on the rapidity of clinical deterioration. POCS model reached a performance similar to SAPS-II.
Highlights
PCT represents a quantitative biomarker which is currently used to help predicting the probability of bacterial infections[4] and guide the duration of antibiotic therapy[5]
We evaluated the in-hospital length of stay and the free time from adverse event (TF-AE), defined as the time occurred between hospitalization and the occurrence of the main clinical endpoint, calculated by Kaplan-Meier’s statistics
From an initial screened sample of 6562 patients admitted to the medical stepdown beds unit (SDU) of the University-Hospital “Azienda Ospedaliero-Universitaria Ospedali Riuniti” of Ancona (Italy), we excluded 5499 subjects for absence of inclusion criteria or presence of at least one exclusion criteria
Summary
PCT represents a quantitative biomarker which is currently used to help predicting the probability of bacterial infections[4] and guide the duration of antibiotic therapy[5]. PCT demonstrated a diagnostic, and an elevated prognostic value in septic patients. A recent meta-analysis concluded that increased PCT concentrations and absence of PCT clearance were strongly associated with all-cause mortality in septic patients[6]. Clinical and pathophysiological data suggest a role of PCT in prognostic evaluation of critically-ill patients regardless the presence of a bacterial infection[7], but large and conclusive data are still lacking. Main objective of the present study was to assess the prognostic value of PCT, evaluated as a single assay at the admission (aPCT) within the first 12 hours, in critically-ill patients regardless of the presence of bacterial infection. We engineered a new predictive model, named “Procalcitonin and Other Clinical Score” (POCS), adopting both clinical and laboratoristic variables (aPCT, age and shock), to improve the prediction of outcomes and compared its performances with other validated prognostic markers, as Troponin I (TnI)[8] and the Simplified Acute Physiology Score II (SAPS-II)[9]
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