Usefulness of procalcitonin clearance as a prognostic biomarker in septic shock. A prospective pilot study

Objective: To evaluate procalcitonin clearance as a prognostic biomarker in septic shock. Design: Prospective, observational pilot study. Setting: Intensive care unit. Patients: Patients admitted to the ICU due to septic shock and multiorgan dysfunction. Interventions: Serum concentrations of procalcitonin were determined within 12h of onset of septic shock and multiorgan dysfunction (coinciding with admission to the ICU), and the following extractions were obtained after 24, 48 and 72h in patients who survived. Data collected: Demographic data, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score, data on the primary focus of infection, and patient outcome (ICU mortality). Results: Procalcitonin clearance was higher in survivors than in non-survivors, with significant differences at 24h (73.9 [56.4-83.8]% vs 22.7 [-331-58.4], p<0.05) and 48h (81.6 [71.6-91.3]% vs -7.29 [-108.2-82.3], p<0.05). The area under the ROC curve was 0.74 (95%CI, 0.54-0.95, p<0.05) for procalcitonin clearance at 24h, and 0.86 (95%CI, 0.69-1.0, p<0.05) at 48h. Conclusions: ICU mortality was associated to sustained high procalcitonin levels, suggesting that procalcitonin clearance at 48h may be a valuable prognostic biomarker (AU)

Objetivo: Evaluar el aclaramiento de procalcitonina como biomarcador pronóstico del shock séptico. Diseño: Estudio piloto, observacional y prospectivo. Ámbito: Servicio de Medicina Intensiva. Pacientes: Enfermos ingresados en el Servicio de Medicina Intensiva por shock séptico y disfunción multiorgánica. Intervenciones: Determinación de las concentraciones séricas de procalcitonina en las primeras 12h de evolución del shock séptico (coincidiendo con el ingreso en el Servicio de Medicina Intensiva) y posteriormente a las 24 horas, 48 horas y a las 72 horas en los pacientes supervivientes. Variables recogidas: datos demográficos, score Acute Physiology and Chronic Health Evaluation II, score Sequential Organ Failure Assessment, datos relativos al foco de sepsis y al resultado del paciente (mortalidad en el Servicio de Medicina Intensiva). Resultados: El aclaramiento de procalcitonina fue mayor en los pacientes supervivientes respecto a los no supervivientes, con diferencias significativas a las 24 horas (73,9 [56,4-83,8]% vs 22,7 [-331-58,4], p<0,05) y las 48 horas (81,6 [71,6-91,3]% vs -7,29 [-108,2-82,3], p<0,05). El área por debajo de la curva ROC fue 0,74 (IC del 95%, 0,54 a 0,95, p<0,05) para el aclaramiento de procalcitonina a las 24 horas y 0,86 (IC del 95%, 0,69 a 1,0, p<0,05) para el aclaramiento de procalcitonina a las 48 horas. Conclusiones: La persistencia de concentraciones elevadas de procalcitonina se asoció a una mayor mortalidad. El aclaramiento de procalcitonina realizado a las 48h puede ser de utilidad como biomarcador pronóstico (AU)

Usefulness of procalcitonin clearance as a prognostic biomarker in septic shock. A prospective pilot study.

OBJECTIVE: To evaluate procalcitonin clearance as a prognostic biomarker in septic shock. DESIGN: Prospective, observational pilot study. SETTING: Intensive care unit. PATIENTS: Patients admitted to the ICU due to septic shock and multiorgan dysfunction. INTERVENTIONS: Serum concentrations of procalcitonin were determined within 12h of onset of septic shock and multiorgan dysfunction (coinciding with admission to the ICU), and the following extractions were obtained after 24, 48 and 72h in patients who survived. DATA COLLECTED: Demographic data, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score, data on the primary focus of infection, and patient outcome (ICU mortality). RESULTS: Procalcitonin clearance was higher in survivors than in non-survivors, with significant differences at 24h (73.9 [56.4-83.8]% vs 22.7 [-331-58.4], p<0.05) and 48h (81.6 [71.6-91.3]% vs -7.29 [-108.2-82.3], p<0.05). The area under the ROC curve was 0.74 (95%CI, 0.54-0.95, p<0.05) for procalcitonin clearance at 24h, and 0.86 (95%CI, 0.69-1.0, p<0.05) at 48h. CONCLUSIONS: ICU mortality was associated to sustained high procalcitonin levels, suggesting that procalcitonin clearance at 48h may be a valuable prognostic biomarker.