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Mulaibisevic, A.
Procalcitonin and non-specific Markers for Predicition of Survival Outcome in Severe Sepsis. A One-Year Retrospective Study
[ Dissertation ] Medical University of Graz; 2005. pp.

Authors Med Uni Graz:
Advisor:: Metzler Helfried
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Abstract:: OBJECTIVE The early identificatin of patients at high risk of dying, through a fast and readily abailable laboratory parameter may help in determining therapeutic intervention that would have a major impact on the outcome (PCT) and other non-specific sepsis markers could be useful predictors of sepsis-related mortality. DESIGN Retrospective oberservation consecutive clinical study. SETTING University hospital intensive care unit (ICU). PATIENTS Over a period of one year, out of consecutive 526 patients, a subset of 38 patients with severe sepsis at ICU admission was investigated. INTERVENTION - PCT and non-specific inflammatory markers; C-reactive protein (CRP), fibrinogen, antithrombin III (AT III), creatinine clearance (Cr Cl), mean arterial pressure (MAP), leukocyte count and body temperature were recorded on the day of admission and over the following days of ICU stay. MEASUREMENTS AND RESULTS: PCT area under the Receiver Operating Characteristic (ROC) curves of 0.92 was highly predictive of fatal outcome. PCT cut-off value of 3.1 ng/ml at day 6 yielded the best discriminative power. After ICU admission PCT steadily declined in survivors compared to a steady increase in nonsurvivors. The ROC for AT II (0.61), fibrinogen (0.65), CRP (0.67) and leukocyte count (0.54) could not predict fatal outcome. The ROC for Cr Cl (0.72), APACHE II score (0.74, MAP (0.69) and body temperature (0.72) was not highly predictive. CONCLUSION PCT was the only parameter with high discriminative power for the predication of mortality in our ICU patients with severe sepsis. Our results indicated that patient with PCT above 3.1 ng/ml by day 6 are at extremely high risk of dying. Thus we recommend an aggressive PCT-guided therapy to be adopted as soon as patient with a presumed severe sepsis are admitted to the ICU aiming at lowering the PCT levels below 3.1 by day 6.