[The predictor value of peripheral blood procalcitonin levels in the evaluation of prognosis of patients with septic shock].

OBJECTIVE: To investigate the predictor value of peripheral blood procalcitonin (PCT) levels in the evaluation of prognosis of patients with septic shock. METHODS: A prospective study was conducted. Eighty-four patients with septic shock in intensive care unit (ICU) of Beijing Shijitan Hospital Affiliated to Capital Medical University were enrolled from May, 2011 to January, 2012. Serum PCT levels were monitored, and the acute physiology and chronic health evaluation II (APACHEII) score, sequential organ failure assessment (SOFA) score were recorded at the 1st, 3rd, 5th, and 7th day after admission. According to the 28-day outcome after admission to ICU, the patients with septic shock were divided into the survivor group and non-survivor group, dynamic changes in serum PCT levels were compared between two groups and correlation analysis was carried out on serum PCT levels and the APACHEII score, SOFA score. RESULTS: (1) There was no significant difference in serum PCT levels (µg/L) at the 1st and 3rd day between survivor group (n=38) and non-survivor group (n=46), but the serum PCT levels at the 5th and 7th day in non-survivor group were significantly higher than that in survivor group (5 days: 8.79±2.38 vs. 2.38±0.88, 7 days: 12.57±3.29 vs. 0.71±0.22, both P<0.05), and the drop of PCT concentrations were significant compared with survivor group (1.91±1.21 vs. 10.27±4.49, P<0.05). At the same time, positive statistical correlation was found between serum PCT levels and APACHEII score, SOFA score (5 days: R(APACHEII)=0.395, R(SOFA)=0.396; 7 days: R(APACHEII)=0.675, R(SOFA)=0.648, all P<0.01). (2) Receiver operator characteristic curve (ROC curve) of serum PCT levels on the 7th day could significantly predict the 28-day mortality, maximal area under the curve (AUC) of PCT was 0.886. When PCT was 0.965 µg/L, the sensitivity and specificity were appropriate. By multivariate factors logistic regression, serum PCT concentrations were not significantly correlated with 28-day mortality. (3) The median survival time (days) of patients with 7-day PCT <1.0 µg/L was far more than that of the patients with PCT>1.0 µg/L (28.0 vs. 14.1, P<0.05). CONCLUSIONS: Dynamic monitoring of serum PCT levels can help to assessment the prognosis of septic shock and also in predicting the severity of the illness, but it may not be a significant independent prognostic marker for 28-day survival in the patients with septic shock.

[The clinical application and value of intra-aortic balloon pump in patients with septic shock].

OBJECTIVE: To investigate the clinical efficacy and value of intra-aortic balloon pump (IABP) with vasoactive drugs for septic shock patients. METHODS: A method of single-centre registry was conducted. Data were collected from 78 consecutive septic shock patients in late stage in intensive care unit (ICU) of Beijing Shijitan Hospital diagnosed between July 2006 and October 2010. With the consent of family members of the patients, they were divided into two groups: group A, in whom only vasoactive drugs were used (dopamine + norepinephrine treatment, n = 39), and group B, in whom vasoactive drugs were used combined with IABP (dopamine + norepinephrine + IABP therapy, n = 39). Before and after treatment of two groups, hemodynamic and tissue perfusion monitoring were executed. At the same time, the shock recovery time, the doses of vasoactive drugs, length of ICU stay, and mortality within 28 days were observed. RESULTS: There was no significant difference in all above parameters between two groups. After treatment, heart rate, blood pressure and heart function parameters were significantly improved compared with those before treatment. In group B, mean arterial pressure (MAP, mm Hg,1 mm Hg = 0.133 kPa) 24 hours and 72 hours after IABP, cardiac index [CI, L×min(-1)× m(-2)] after 48 hours of IABP, and in 2 hours after termination of IABP, dopamine dosage [µg×kg(-1)×min(-1)] in 24, 48, 72 hours after IABP and 2 hours after termination were significantly improved than those in group A (MAP: 53.0 ± 6.3 vs. 52.1 ± 6.2, 65.6 ± 4.3 vs. 65.0 ± 2.1; CI: 3.40 ± 0.20 vs. 3.30 ± 0.50, 3.60 ± 0.30 vs. 3.60 ± 0.30; dopamine dosage: 17.5 ± 1.2 vs. 17.6 ± 1.3, 10.2 ± 1.3 vs. 12.8 ± 1.6, 5.8 ± 1.5 vs. 6.8 ± 1.7, 3.0 ± 0.7 vs. 4.1 ± 1.3, P < 0.05 or P < 0.01). Compared with group A, shock recovery time (days) of group B was significantly shorter (10.4 ± 2.2 vs. 14.1 ± 3.4, P < 0.01) than that of group A; mortality within 28 days was significantly lower (34.1% vs. 45.6%, P < 0.01) in group B; length of ICU stay of two groups showed no significant difference between two groups. CONCLUSIONS: IABP in patients with septic shock significantly improved hemodynamics, increased coronary and systemic tissue perfusion, reduced cardiac afterload, elevated CI, reduced doses of vasoactive drugs, shortened length of ICU stay, improved prognosis, and lowered the mortality rate. IABP had important clinical value, and could be recommended as an additional treatment option in patients with septic shock in whom the effect of drug was poor.