Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients

Critical Care

Eric Gluck³  Devendra N Amin¹  Ami Desai³  Vikas Punjabi³  Paula Maurer¹  Philipp Schuetz² 

[1] Medical/Surgical Intensive Care Unit, Morton Plant Hospital, 300 Pinellas Street, Clearwater, FL 33756, USA;Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA;Department of Critical Care Medicine, Swedish Covenant Hospital, 5145 N. California Ave, Chicago, IL 60625-3642, USA

关键词: Clinical risk score;    SAPS II;    APACHE IV;    Mortality prediction;    Mortality;    Procalcitonin change;    Procalcitonin kinetics;    Procalcitonin;    Biomarker;    Septic shock;    Severe sepsis;    Sepsis;   

Others  :  818114
DOI  :  10.1186/cc12787

 received in 2013-01-07, accepted in 2013-06-20,  发布年份 2013

【 摘 要 】

Introduction

Close monitoring and repeated risk assessment of sepsis patients in the intensive care unit (ICU) is important for decisions regarding care intensification or early discharge to the ward. We studied whether considering plasma kinetics of procalcitonin, a biomarker of systemic bacterial infection, over the first 72 critical care hours improved mortality prognostication of septic patients from two US settings.

Methods

This retrospective analysis included consecutively treated eligible adults with a diagnosis of sepsis from critical care units in two independent institutions in Clearwater, FL and Chicago, IL. Cohorts were used for derivation or validation to study the association between procalcitonin change over the first 72 critical care hours and mortality.

Results

ICU/in-hospital mortality rates were 29.2%/31.8% in the derivation cohort (n = 154) and 17.6%/29.4% in the validation cohort (n = 102). In logistic regression analysis of both cohorts, procalcitonin change was strongly associated with ICU and in-hospital mortality independent of clinical risk scores (Acute Physiology, Age and Chronic Health Evaluation IV or Simplified Acute Physiology Score II), with area under the curve (AUC) from 0.67 to 0.71. When procalcitonin decreased by at least 80%, the negative predictive value for ICU/in-hospital mortality was 90%/90% in the derivation cohort, and 91%/79% in the validation cohort. When procalcitonin showed no decrease or increased, the respective positive predictive values were 48%/48% and 36%/52%.

Discussion

In septic patients, procalcitonin kinetics over the first 72 critical care hours provide prognostic information beyond that available from clinical risk scores. If these observations are confirmed, procalcitonin monitoring may assist physician decision-making regarding care intensification or early transfer from the ICU to the floor.

【 授权许可】

   
2013 Schuetz et al.; licensee BioMed Central Ltd.

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