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

Sari Karlsson1*, Milja Heikkinen2, Ville Pettilä3, Seija Alila4, Sari Väisänen2, Kari Pulkki2, Elina Kolho5, Esko Ruokonen6 and the Finnsepsis Study Group1

Author Affiliations

1 Department of Intensive Care Medicine, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland

2 Department of Clinical Chemistry, University of Eastern Finland and Eastern Finland Laboratory Centre, Puijonlaaksontie 2, 70211 Kuopio, Finland

3 Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland

4 Department of Anaesthesia and Intensive Care Medicine, Kymenlaakso Central Hospital, Kotkantie 41, 48210 Kotka, Finland

5 Division of Infectious Diseases, Department of Medicine, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland

6 Department of Intensive Care Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70211 Kuopio, Finland

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Critical Care 2010, 14:R205  doi:10.1186/cc9327


See related commentary by Wolff and Bouadma, http://ccforum.com/content/14/6/1007

Published: 15 November 2010

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.