ABSTRACT
AIMS: To investigate the clinical benefit of routine procalcitonin (PCT) measurement in the medical intensive care unit (ICU) of a tertiary referral hospital. METHODS: Adult patients with suspected infections were included. White blood cells, Creactive protein (CRP), and PCT were measured. RESULTS: In this study 129 patients of median age 64 years (interquartile range 39-89â¯years) were prospectively included. The Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were 21⯱ 14 and 7⯱ 6, respectively. Intensive care unit (ICU) mortality was 22.5%. Immunocompromised patients constituted 39.5%. A significant correlation was observed between PCT and APACHE II (Spearman's rho 0.461, pâ¯< 0.01), PCT and SOFA (Spearman's rho 0.494, pâ¯< 0.01) and PCT and CRP (Spearman's rho 0.403, pâ¯< 0.01). Most patients (nâ¯= 83, 64.3%) received antibiotics before admission. No difference in PCT (1.56⯱ 8⯵g/L vs. 1.44⯱ 13⯵g/L, pâ¯= 0.6) was observed with respect to previous antibiotic therapy. Levels of PCT and CRP were significantly increased in patients with positive blood cultures, the infection caused by Gram-negative microorganism regardless of disease severity and pneumonia with complications. PCT did not differ among patients with positive vs negative urine culture (4.6⯱ 16⯵g/L vs. 1.76⯱ 11.9⯵g/L) or positive vs. negative endotracheal aspirate (1.93⯱ 11.4⯵g/L vs. 1.76⯱ 1.11⯵g/L). PCT-guided stewardship was applied in 36 patients (28%). CONCLUSION: Increased initial PCT levels might point to the development of more severe disease caused by Gram-negative bacteria, regardless of previous antibiotic treatment. The results pertain to immunocompetent and immunocompromised patients. Implementation of PCT-guided stewardship in those patients is possible and relies on experience as well as knowledge of reference change value for a marker within the specific setting.