The Prognostic Role of Procalcitonin in Critically Ill Patients Admitted in a Medical Stepdown Unit: A Retrospective Cohort Study

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. Procalcitonin (PCT) is a pro-hormone of human calcitonin synthesized by the parafollicular C cells of the thyroid and involved in calcium homeostasis. PCT is produced in large quantities by different cell types in patients affected by bacterial infections 1. Several studies have shown low-to moderately-elevated PCT levels also among critically-ill patients without evidence of infection (trauma, major surgery, multi-organ failure and myocardial infarction) 2,3. Clinically, 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 not only a diagnostic, but also 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 also 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 ...

Nutritional risk factors for all-cause mortality of critically ill patients: a retrospective cohort study

“… 14 In addition, PCT could be a good predictor of prognosis in critically ill patients. 13 The results of this study proved that PCT could be predictive of 28-day outcomes in enterally fed critically ill patients.…”

Prognostic Role of Serum Procalcitonin Measurement in Adult Patients Admitted to the Emergency Department with Fever

“…To date, the association of a high level of PCT with a poor prognosis has been widely analyzed in several clinical contexts [5,8,[13][14][15][16][17][18][19][20]. At the same time, the possible correlation between a high level of PCT and prognosis may have a crucial role in the management of patients with fever of possible infective origin, particularly in ED [24][25][26][27][28][29][30].…”

“…While PCT has a confirmed clinical utility both in risk stratification and in antibiotic management [12,[16][17][18][19][20][32][33][34][35][36][37], its relevance for patient's level outcomes is still debated. Considering ICU patients, recent meta-analyses seem to confirm the positive impact of PCTguided management on survival [15,36].…”

“…Since then, several studies have described the possible role of PCT as a prognostic marker for sepsis. Nevertheless, although the International Guidelines for Management of Sepsis and Septic shock of 2016 recommend the use of PCT as a prognostic biomarker for sepsis [11], evidence from the literature is still contradictory [2,5,6,[12][13][14][15][16][17][18][19][20]. Moreover, in the last few years, several studies have suggested that PCT may play a role in the prognostic assessment of all critically ill patients regardless of the presence of septic complications [16,21,22].…”

COVID-19 pneumonia and the appropriate use of antibiotics

“…3 Although many serum biomarkers lack specificity, increased procalcitonin concentrations have been investigated as a specific bacterial differentiation from viral response to bacterial respiratory tract infection. 4,5 From accumulating data and reports, there appears to be a clear association between elevated concentrations of procalcitonin and increasing COVID-19 disease severity, despite a variety of cutoffs chosen. 6,7 Most bacterial pneumonias caught early enough can be safely and effectively treated with antibiotics, and broad-spectrum antibiotics are being widely used in patients with COVID-19.…”