Prognostic value of procalcitonin clearance rate and sequential organ failure assessment score in septic shock children / 中国小儿急救医学

ABSTRACT

Objective To assess the disease severity and prognosis value by observing the kinetic change of serum procalcitonin(PCT),PCT clearance rate(PCT-C) and &Delta;sequential organ failure assessment (&Delta;SOFA) score in the patients with septic shock.Methods A single-center observational study was conduc-ted.A total of 274 patients with septic shock admitted into intensive care unit of Hunan Province Children′s Hospital from July 2013 to December 2015 were enrolled.The patients were divided into survival group(n=178) and nonsurvival group(n=96)according to the therapeutic outcome on day 28.The PCT and SOFA scores were estimated within 24 hours when septic shock was diagnosed.PCT-C and &Delta;SOFA were examined on day 2,day 3,day 5,day 7,day 9 after the septic shock was diagnosed.The diagnostic and predictive per-formance of PCT,PCT-C and &Delta;SOFA score were assessed by the receiver operating characteristic curve (ROC).Results There were no statistical differences on serum concentrations of PCT at 24 hour,48 hour, 72 hour between two groups.But PCT-C in survival group on day 2,day 3,day 5,day 7,day 9 were signifi-cant higher than those of nonsurvival group.The area under the ROC curve were 0.800(95%CI 0.69~0.91, P=0.000)for PCT-C on day 9,0.980(95%CI 0.78 ~0.95,P<0.000)for &Delta;SOFA on day 9 and 0.779 (95%CI 0.66 ~0.89,P <0.001)for SOFA score when septic shock was diagnosed. A ROC analysis identified a PCT-C on day 9 more than 38.98%(sensitivity78.90%,specificity66.80%) as the most accurate cut-off in predicting death.A ROC analysis identified &Delta;SOFA score on day 9 less than -0.5(sensi-tivity89.10%,specificity91.50%) as the most accurate cut-off in predicting death. Conclusion The increased levels of PCT in patients with septic shock were associated with the poor control of infection and may indicate the deterioration of septic shock,it also can reflect the activity of infection in time. Keeping observing the dynamic change of PCT and analyzing PCT-C are more useful.The PCT-C levels and &Delta;SOFA score may provide evidence of disease progression and be helpful in risk stratification in patients with septic shock,and lower level of PCT-C and &Delta;SOFA score may accompany serious infection and predict poor prognosis.