Limits...
Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit.

Pieralli F, Vannucchi V, Mancini A, Antonielli E, Luise F, Sammicheli L, Turchi V, Para O, Bacci F, Nozzoli C - J Clin Med Res (2015)

Bottom Line: The final study group of 144 patients featured a mean age of 73 ± 14 years, with a high prevalence of comorbidities (Charlson index greater than 6 in 39%).A receiver-operating-characteristic (ROC) analysis identified a decrease of Δ-PCT0-72h less than 15% (area under the curve: 0.75; 95% confidence interval (CI): 0.67 - 0.82) and a decrease of Δ-PCT24-72h less than 20% (area under the curve: 0.83; 95% CI: 0.74 - 0.92) as the most accurate cut-offs in predicting mortality.Decreases of Δ-PCT0-72h less than 15% (HR: 3.9, 95% CI: 1.6 - 9.5; P < 0.0001) and Δ-PCT24-72h less than 20% (HR: 3.1, 95% CI: 1.2 - 7.9; P < 0.001) were independent predictors of 30-day mortality.

View Article: PubMed Central - PubMed

Affiliation: Internal and Emergency Medicine Unit, Careggi University Hospital, Florence, Italy.

ABSTRACT

Background: Severe sepsis and septic shock are leading causes of morbidity and mortality among critically ill patients, thus the identification of prognostic factors is crucial to determine their outcome. In this study, we explored the value of procalcitonin (PCT) variation in predicting 30-day mortality in patients with sepsis admitted to an intermediate care unit.

Methods: This prospective observational study enrolled 789 consecutive patients with severe sepsis and septic shock admitted to a medical intermediate care unit between November 2012 and February 2014. Kinetics of PCT expressed as percentage were defined by the variation between admission and 72 hours, and 24 and 72 hours; they were defined as Δ-PCT0-72h and Δ-PCT24-72h, respectively.

Results: The final study group of 144 patients featured a mean age of 73 ± 14 years, with a high prevalence of comorbidities (Charlson index greater than 6 in 39%). Overall, 30-day mortality was 28.5% (41/144 patients). A receiver-operating-characteristic (ROC) analysis identified a decrease of Δ-PCT0-72h less than 15% (area under the curve: 0.75; 95% confidence interval (CI): 0.67 - 0.82) and a decrease of Δ-PCT24-72h less than 20% (area under the curve: 0.83; 95% CI: 0.74 - 0.92) as the most accurate cut-offs in predicting mortality. Decreases of Δ-PCT0-72h less than 15% (HR: 3.9, 95% CI: 1.6 - 9.5; P < 0.0001) and Δ-PCT24-72h less than 20% (HR: 3.1, 95% CI: 1.2 - 7.9; P < 0.001) were independent predictors of 30-day mortality.

Conclusions: Evaluation of PCT kinetics over the first 72 hours is a useful tool for predicting 30-day mortality in patients with severe sepsis and septic shock admitted to an intermediate care unit.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier estimation of probability of survival curves for different procalcitonin percentage variations (Δ-PCT) at different time intervals. (a) Δ-PCT percentage decrease between day 0 and 72 h greater or less than 15% in predicting survival; log rank test P < 0.000; 95% CI: 29.8 - 41.3. (b) Δ-PCT percentage decrease between 24 and 72 h greater or less than 20% in predicting survival; log rank test P < 0.0001; 95% CI: 11.4 - 27.8.
© Copyright Policy - open access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4522989&req=5

Figure 2: Kaplan-Meier estimation of probability of survival curves for different procalcitonin percentage variations (Δ-PCT) at different time intervals. (a) Δ-PCT percentage decrease between day 0 and 72 h greater or less than 15% in predicting survival; log rank test P < 0.000; 95% CI: 29.8 - 41.3. (b) Δ-PCT percentage decrease between 24 and 72 h greater or less than 20% in predicting survival; log rank test P < 0.0001; 95% CI: 11.4 - 27.8.

Mentions: Results of univariate and multivariate logistic regression analysis of several demographic, clinical characteristics and biohumoral markers analysed are shown in Table 2. Interestingly, the univariate logistic regression analysis highlighted that a decrease of Δ-PCT0-72h < 15% was predictive of adverse outcome with a 6.1 HR (95% CI: 2.7 - 13.6; P < 0.0001) and that a Δ-PCT24-72h < 20% was predictive of adverse outcome with a 5.9 HR (95% CI: 2.5 - 14.1; P < 0.0001). At multivariate logistic regression analysis assessing the association of several variables with risk of 30-day mortality, Δ-PCT0-72h decrease less than 15% and Δ-PCT24-72h decrease less than 20% retained their independent predictive role with an HR of 3.9 (95% CI: 1.6 - 9.5; P < 0.0001) and of 3.1 (95% CI: 1.2 - 7.9; P < 0.001), respectively (Table 3). Kaplan-Meier event-free survival estimate curves for the corresponding Δ-PCT values are shown in Figure 2.


Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit.

Pieralli F, Vannucchi V, Mancini A, Antonielli E, Luise F, Sammicheli L, Turchi V, Para O, Bacci F, Nozzoli C - J Clin Med Res (2015)

Kaplan-Meier estimation of probability of survival curves for different procalcitonin percentage variations (Δ-PCT) at different time intervals. (a) Δ-PCT percentage decrease between day 0 and 72 h greater or less than 15% in predicting survival; log rank test P < 0.000; 95% CI: 29.8 - 41.3. (b) Δ-PCT percentage decrease between 24 and 72 h greater or less than 20% in predicting survival; log rank test P < 0.0001; 95% CI: 11.4 - 27.8.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522989&req=5

Figure 2: Kaplan-Meier estimation of probability of survival curves for different procalcitonin percentage variations (Δ-PCT) at different time intervals. (a) Δ-PCT percentage decrease between day 0 and 72 h greater or less than 15% in predicting survival; log rank test P < 0.000; 95% CI: 29.8 - 41.3. (b) Δ-PCT percentage decrease between 24 and 72 h greater or less than 20% in predicting survival; log rank test P < 0.0001; 95% CI: 11.4 - 27.8.
Mentions: Results of univariate and multivariate logistic regression analysis of several demographic, clinical characteristics and biohumoral markers analysed are shown in Table 2. Interestingly, the univariate logistic regression analysis highlighted that a decrease of Δ-PCT0-72h < 15% was predictive of adverse outcome with a 6.1 HR (95% CI: 2.7 - 13.6; P < 0.0001) and that a Δ-PCT24-72h < 20% was predictive of adverse outcome with a 5.9 HR (95% CI: 2.5 - 14.1; P < 0.0001). At multivariate logistic regression analysis assessing the association of several variables with risk of 30-day mortality, Δ-PCT0-72h decrease less than 15% and Δ-PCT24-72h decrease less than 20% retained their independent predictive role with an HR of 3.9 (95% CI: 1.6 - 9.5; P < 0.0001) and of 3.1 (95% CI: 1.2 - 7.9; P < 0.001), respectively (Table 3). Kaplan-Meier event-free survival estimate curves for the corresponding Δ-PCT values are shown in Figure 2.

Bottom Line: The final study group of 144 patients featured a mean age of 73 ± 14 years, with a high prevalence of comorbidities (Charlson index greater than 6 in 39%).A receiver-operating-characteristic (ROC) analysis identified a decrease of Δ-PCT0-72h less than 15% (area under the curve: 0.75; 95% confidence interval (CI): 0.67 - 0.82) and a decrease of Δ-PCT24-72h less than 20% (area under the curve: 0.83; 95% CI: 0.74 - 0.92) as the most accurate cut-offs in predicting mortality.Decreases of Δ-PCT0-72h less than 15% (HR: 3.9, 95% CI: 1.6 - 9.5; P < 0.0001) and Δ-PCT24-72h less than 20% (HR: 3.1, 95% CI: 1.2 - 7.9; P < 0.001) were independent predictors of 30-day mortality.

View Article: PubMed Central - PubMed

Affiliation: Internal and Emergency Medicine Unit, Careggi University Hospital, Florence, Italy.

ABSTRACT

Background: Severe sepsis and septic shock are leading causes of morbidity and mortality among critically ill patients, thus the identification of prognostic factors is crucial to determine their outcome. In this study, we explored the value of procalcitonin (PCT) variation in predicting 30-day mortality in patients with sepsis admitted to an intermediate care unit.

Methods: This prospective observational study enrolled 789 consecutive patients with severe sepsis and septic shock admitted to a medical intermediate care unit between November 2012 and February 2014. Kinetics of PCT expressed as percentage were defined by the variation between admission and 72 hours, and 24 and 72 hours; they were defined as Δ-PCT0-72h and Δ-PCT24-72h, respectively.

Results: The final study group of 144 patients featured a mean age of 73 ± 14 years, with a high prevalence of comorbidities (Charlson index greater than 6 in 39%). Overall, 30-day mortality was 28.5% (41/144 patients). A receiver-operating-characteristic (ROC) analysis identified a decrease of Δ-PCT0-72h less than 15% (area under the curve: 0.75; 95% confidence interval (CI): 0.67 - 0.82) and a decrease of Δ-PCT24-72h less than 20% (area under the curve: 0.83; 95% CI: 0.74 - 0.92) as the most accurate cut-offs in predicting mortality. Decreases of Δ-PCT0-72h less than 15% (HR: 3.9, 95% CI: 1.6 - 9.5; P < 0.0001) and Δ-PCT24-72h less than 20% (HR: 3.1, 95% CI: 1.2 - 7.9; P < 0.001) were independent predictors of 30-day mortality.

Conclusions: Evaluation of PCT kinetics over the first 72 hours is a useful tool for predicting 30-day mortality in patients with severe sepsis and septic shock admitted to an intermediate care unit.

No MeSH data available.


Related in: MedlinePlus