Procalcitonin as an early indicator of outcome in sepsis: a prospective observational study - 02/08/11

Doi : 10.1016/j.jhin.2010.07.026

E.J. Giamarellos-Bourboulis ^a,^⁎ , I. Tsangaris ^b, Th. Kanni ^a, M. Mouktaroudi ^a, I. Pantelidou ^a, G. Adamis ^c, S. Atmatzidis ^d, M. Chrisofos ^e, V. Evangelopoulou ^f, F. Frantzeskaki ^b, P. Giannopoulos ^g, G. Giannikopoulos ^h, D. Gialvalis ⁱ, G.M. Gourgoulis ^a, K. Kotzampassi ^j, K. Katsifa ^k, G. Kofinas ^l, F. Kontopidou ^a, G. Koratzanis ^m, V. Koulouras ⁿ, A. Koutsikou ^o, M. Koupetori ^p, I. Kritselis ^q, L. Leonidou ^r, A. Mega ^s, V. Mylona ^m, H. Nikolaou ^t, S. Orfanos ^b, P. Panagopoulos ^a, E. Paramythiotou ^b, A. Papadopoulos ^a, X. Papanikolaou ^l, M. Pavlaki ^u, V. Polychronopoulos ^v, A. Skoutelis ^w, A. Theodotou ^x, M. Vassiliaghou ^y, E.E. Douzinas ^z, C. Gogos ^r, A. Armaganidis ^b
on behalf of the Hellenic Sepsis Study Group
^a 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece
^b 2nd Department of Critical Care, University of Athens, Medical School, Athens, Greece
^c 1st Department of Internal Medicine, ‘G. Gennimatas’ Athens Hospital, Athens, Greece
^d 2nd Department of Surgery, University of Thessaloniki, Medical School, Thessaloniki, Greece
^e 2nd Department of Urology, ‘Sismanogleion’ Athens Hospital, Athens, Greece
^f Intensive Care Unit, ‘Korgialeneion-Benakeion’ Hospital of Athens, Athens, Greece
^g 1st Department Propedeutic Surgery, University of Athens, Medical School, Athens, Greece
^h Department of Internal Medicine, Chios General Hospital, Chios, Greece
ⁱ 2nd Department of Surgery, ‘Evangelismos’ Athens General Hospital, Athens, Greece
^j 1st Department Prop. Surgery, University of Thessaloniki, Medical School Thessaloniki, Greece
^k Intensive Care Unit, ‘Tzaneion’ Hospital of Piraeus, Piraeus, Greece
^l Intensive Care Unit, ‘Hippokrateion’ Athens General Hospital, Athens, Greece
^m 2nd Department of Internal Medicine, ‘Sismanogleion’ Athens Hospital, Athens, Greece
ⁿ Department of Critical Care, University of Ioannina Medical School, Ioannina, Greece
^o Intensive Care Unit, ‘Thriassio’ Elefsina General Hospital, Elefsina, Greece
^p 1st Department of Internal Medicine, ‘Thriassio’ Elefsina General Hospital, Elefsina, Greece
^q Department of Surgery, Nafplion General Hospital, Nafplion, Greece
^r 1st Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
^s Intensive Care Unit, ‘Laikon’ Athens General Hospital, Athens, Greece
^t Intensive Care Unit, ‘Aghia Olga’ Athens General Hospital, Athens, Greece
^u Department of Internal Medicine, Argos General Hospital, Argos, Greece
^v 3rd Department of Pulmonary Medicine, ‘Sismanoglion’ Athens Hospital, Athens, Greece
^w 5th Department of Internal Medicine, ‘Evangelismos’ Athens Hospital, Athens, Greece
^x Intensive Care Unit, Karditsa General Hospital, Karditsa, Greece
^y Intensive Care Unit, ‘G. Gennimatas’ Thessaloniki General Hospital, Thessaloniki, Greece
^z 3rd Department of Critical Care, University of Athens, Medical School, Athens, Greece

Corresponding author. Address: 4th Department of Internal Medicine, ATTIKON University General Hospital, 124 62 Athens, Greece. Tel.: +30 210 58 31 994; fax: +30 210 53 26 446.

Summary

This study explores the role of procalcitonin (PCT) in predicting the outcome of sepsis. In a prospective multicentre observational investigation, blood was sampled within 24h of onset of sepsis in 1156 hospitalised patients; 234 were in the intensive care unit (ICU) at the point of presentation of sepsis while 922 were not. PCT was estimated in serum by the ultrasensitive Kryptor assay in a double-blinded fashion. Among patients outside the ICU, mortality was 8% in those with PCT ≤0.12ng/mL but 19.9% in those with PCT >0.12ng/mL [P<0.0001, odds ratio (OR) for death: 2.606; 95% confidence interval (CI): 1.553–4.371]. Among patients whose sepsis presented in ICU, mortality was 25.6% in those with PCT ≤0.85ng/mL but 45.3% in those with PCT >0.85ng/mL (P=0.002; OR for death: 2.404; 95% CI: 1.385–4.171). It is concluded that PCT cut-off concentrations can contribute to predicting the outcome of sepsis and might be of particular value in identifying patients who would benefit from ICU admission.

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Keywords : Procalcitonin, Prognosis, Sepsis

Plan

Introduction

Methods

Study design

Blood sampling and laboratory procedure

Statistical analysis

Results

Patient population

Lack of effect of underlying infection on outcome

PCT as a predictor of outcome for sepsis hospitalised outside the ICU

PCT as a predictor of outcome for sepsis presenting after ICU admission

Changes in PCT with worsening disease

Discussion

Conflict of interest statement

Funding source

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Vol 77 - N° 1

P. 58-63 - janvier 2011 Retour au numéro

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Procalcitonin as an early indicator of outcome in sepsis: a prospective observational study - 02/08/11

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