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

Sari Karlsson, Milja Heikkinen, Ville Pettilä, Seija Alila, Sari Väisänen, Kari Pulkki, Elina Kolho, Esko Ruokonen, Finnsepsis Study Group, Vesa Lund, Marika Vettenranta, Päivi Tuominen, Markku Suvela, Sari Hirvonen, Anne-Marja Turkulainen, Raili Laru-Sompa, Tiina Kirkhope, Heikki Laine, Aki Savinen, Pekka Kettunen, Sari Karlsson, Jaana Kallinen, Vesa Parviainen, Kari Saarinen, Johanna Kristola, Niina Tuominen, Seppo Hovilehto, Sari Melto, Marjut Repo, Tuula Korhonen, Ulla Koponen, Kirsti Pomell, Pentti Kairi, Marianne Ström, Ari Alaspää, Elina Helminen, Outi Kiviniemi, Tarja Laurila, Tadeusz Kaminski, Tea Verronen, Jussi Pentti, Seija Alila, Ville Pettilä, Marjut Varpula, Marja Hynninen, Elina Kolho, Marja Pere, Maiju Salovaara, Tero Varpula, Mirja Vauramo, Rita Linko, Kimmo Kuusisto, Esko Ruokonen, Pertti Arvola, Minna-Liisa Peltola, Anna-Liina Korkala, Jani Heinilä, Ilkka Parviainen, Seija Laitinen, Elina Halonen, Mirja Tiainen, Heikki Ahonen, Tero Ala-Kokko, Jouko Laurila, Tarja Lamberg, Sinikka Sälkiö, Jorma Heikkinen, Kirsi Heinonen, Sari Karlsson, Milja Heikkinen, Ville Pettilä, Seija Alila, Sari Väisänen, Kari Pulkki, Elina Kolho, Esko Ruokonen, Finnsepsis Study Group, Vesa Lund, Marika Vettenranta, Päivi Tuominen, Markku Suvela, Sari Hirvonen, Anne-Marja Turkulainen, Raili Laru-Sompa, Tiina Kirkhope, Heikki Laine, Aki Savinen, Pekka Kettunen, Sari Karlsson, Jaana Kallinen, Vesa Parviainen, Kari Saarinen, Johanna Kristola, Niina Tuominen, Seppo Hovilehto, Sari Melto, Marjut Repo, Tuula Korhonen, Ulla Koponen, Kirsti Pomell, Pentti Kairi, Marianne Ström, Ari Alaspää, Elina Helminen, Outi Kiviniemi, Tarja Laurila, Tadeusz Kaminski, Tea Verronen, Jussi Pentti, Seija Alila, Ville Pettilä, Marjut Varpula, Marja Hynninen, Elina Kolho, Marja Pere, Maiju Salovaara, Tero Varpula, Mirja Vauramo, Rita Linko, Kimmo Kuusisto, Esko Ruokonen, Pertti Arvola, Minna-Liisa Peltola, Anna-Liina Korkala, Jani Heinilä, Ilkka Parviainen, Seija Laitinen, Elina Halonen, Mirja Tiainen, Heikki Ahonen, Tero Ala-Kokko, Jouko Laurila, Tarja Lamberg, Sinikka Sälkiö, Jorma Heikkinen, Kirsi Heinonen

Abstract

Introduction: This 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.

Methods: PCT was analyzed from blood samples of all patients at baseline, and 155 patients 72 hours later.

Results: The 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).

Conclusions: PCT concentrations were higher in more severe forms of severe sepsis, but a substantial concentration decrease was more important for survival than absolute values.

Figures

Figure 1
Figure 1
Flowchart of the study. PCT, procalcitonin.
Figure 2
Figure 2
Procalcitonin (PCT) concentrations in patients with community-acquired or nosocomial infections. P = 0.001 on day 0 and P = 0.003 at 72 hours between the patient groups. PCT concentrations are shown in logarithmic scale and are presented in nanograms per milliliter.
Figure 3
Figure 3
Receiver operating characteristic curve for procalcitonin (PCT) concentration and positive blood culture. Areas under the curve are 0.76 (95% confidence interval [CI] 0.66 to 0.86, P < 0.001) for PCT on day 0 and 0.74 (95% CI 0.64 to 0.84, P < 0.001) for PCT at 72 hours.
Figure 4
Figure 4
Change in procalcitonin (PCT) concentration (ΔPCT/PCT on day 0) in hospital survivors and nonsurvivors. Asterisks refer to difference in PCT change. Positive change is defined as decreasing concentrations.

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