Accuracy of Procalcitonin for Outcome Prediction in Unselected Postoperative Critically Ill Patients

Abstract

The importance of postoperative procalcitonin (PCT) measurements for outcome prediction is currently controversial. Conflicting results have been obtained for patients after polytrauma, sepsis, peritonitis, or cardiac surgery and may result from incomplete adjustment for important confounders or from nonlinear PCT effects. We retrospectively analyzed the association of PCT concentration with postoperative mortality, morbidity, and length of stay in an unselected series of 220 consecutive patients who required postoperative intensive care unit therapy or surveillance. Biochemical markers were measured on the first day after intensive care unit admission. Results were adjusted for various confounding variables (Acute Physiology and Chronic Health Evaluation II score, underlying disease), and test accuracy was evaluated by receiver operating characteristic statistics. We found a significant nonlinear, logarithmic association between PCT concentration and outcome. After adjustment for relevant covariates, PCT was an independent determinant of mortality, combined mortality/morbidity, and postoperative hospital length of stay in survivors. At mortality analysis, the predictive power of PCT was superior to that of Acute Physiology and Chronic Health Evaluation II score and of IL-6 (optimal cutoff point, 1.44 ng/mL; sensitivity, 80.8%; specificity, 80.4%). The use of PCT was comparable to that of other prognostic markers when combined mortality/morbidity were examined. Our results suggest that PCT may deserve further testing as a prognostic tool in unselected, critically ill, surgical patients.

Soluble membrane receptors, interleukin 6, procalcitonin and C reactive protein as prognostic markers in patients with severe sepsis and septic shock

“…Moreover, taking into account the diverse variables that can influence mortality, the performance of a multivariate analysis is a key aspect to detect those parameters independently associated with death. These are two different aspects of this work when compared to other studies that have demonstrated the importance of PCT (or other biomarkers) as a prognostic variable [38–41,43]. Also, it is remarkable that PCT values represent the host response after a bacterial insult.…”

Predictive value of procalcitonin decrease in patients with severe sepsis: a prospective observational study

“…In postoperative critically ill patients, the cutoff point for PCT concentration was 1.44 ng/mL to detect worse outcome [44], which may be due to infection and possible unsuccessful control of the source.…”

Role of Biomarkers in Sepsis Care

“…For instance, several investigators have reported high levels of CRP among patients with burn injury with or without septic complications (16, 20, 21). CRP has also been shown to have a poor predictor of mortality compared to other biomarkers (22, 23). …”