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

Abstract

IntroductionThis prospective study investigated the predictive value of procalcitonin (PCT) for survival in 242 adult patients with severe sepsis and septic shock treated in intensive care.MethodsPCT was analyzed from blood samples of all patients at baseline, and 155 patients 72 hours later.ResultsThe median PCT serum concentration on day 0 was 5.0 ng/ml (interquartile range (IQR) 1.0 and 20.1 ng/ml) and 1.3 ng/ml (IQR 0.5 and 5.8 ng/ml) 72 hours later. Hospital mortality was 25.6% (62/242). Median PCT concentrations in patients with community-acquired infections were higher than with nosocomial infections (P = 0.001). Blood cultures were positive in 28.5% of patients (n = 69), and severe sepsis with positive blood cultures was associated with higher PCT levels than with negative cultures (P = < 0.001). Patients with septic shock had higher PCT concentrations than patients without (P = 0.02). PCT concentrations did not differ between hospital survivors and nonsurvivors (P = 0.64 and P = 0.99, respectively), but mortality was lower in patients whose PCT concentration decreased > 50% (by 72 hours) compared to those with a < 50% decrease (12.2% vs. 29.8%, P = 0.007).ConclusionsPCT concentrations were higher in more severe forms of severe sepsis, but a substantial concentration decrease was more important for survival than absolute values.

Utility Of Procalcitonin As A Diagnostic And Prognostic Biomarker Of Sepsis In Comparison To Culture & Other Inflammatory Markers

“…This was in accordance with the reports of Karlsson et al 18 and Andreola et al 19 though the rate of positive culture was less than ours. Karlsson et al18 also reported of significantly higher PCT levels in positive culture cases compared to that of the negative ones.…”

Serum levels of interleukin‐6 may predict organ dysfunction earlier than SOFA score

“…Procalcitonin has been used widely as a biomarker of bacterial infection 17. However, previous studies reported PCT was not an indicator of organ dysfunction,18 particularly in the severe patient group, which could explain our result. Thus, IL‐6 may more accurately identify organ dysfunction severity than PCT or CRP.…”

Procalcitonina como biomarcador de prognóstico da sepse grave e choque séptico

“…In patients with community-acquired pneumonia with decreased PCT from day one to day three, it was related to survival with 89% specificity, 82% negative predictive value and 71% positive predictive value 25 . Karlsson et al 12 showed in a recent study that mortality in patients with severe sepsis is smaller than in those whose PCT concentrations decreased by over 50% when compared to initial values. Claeys et al 13 , analyzing patients with septic shock, showed that after 48 hours of admission, PCT levels only decreased substantially in the surviving.…”

“…Most studies say that it is not possible to predict the outcome of critically ill patients based on high levels of PCT. Encouraging results were obtained from studies involving small numbers of patients and showed that serial determinations of PTC correlated with prognosis 12,13 . In recent studies, Guan et al 16 and Ruiz-Rodriguez et al 17 suggested, by analyzing small case series, that dynamic changes of PCT could be predictive of outcome in patients with severe sepsis and septic shock.…”