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Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit

BACKGROUND: Severe sepsis and septic shock are leading causes of morbidity and mortality among critically ill patients, thus the identification of prognostic factors is crucial to determine their outcome. In this study, we explored the value of procalcitonin (PCT) variation in predicting 30-day mort...

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Autores principales: Pieralli, Filippo, Vannucchi, Vieri, Mancini, Antonio, Antonielli, Elisa, Luise, Fabio, Sammicheli, Lucia, Turchi, Valerio, Para, Ombretta, Bacci, Francesca, Nozzoli, Carlo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522989/
https://www.ncbi.nlm.nih.gov/pubmed/26251686
http://dx.doi.org/10.14740/jocmr2251w
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author Pieralli, Filippo
Vannucchi, Vieri
Mancini, Antonio
Antonielli, Elisa
Luise, Fabio
Sammicheli, Lucia
Turchi, Valerio
Para, Ombretta
Bacci, Francesca
Nozzoli, Carlo
author_facet Pieralli, Filippo
Vannucchi, Vieri
Mancini, Antonio
Antonielli, Elisa
Luise, Fabio
Sammicheli, Lucia
Turchi, Valerio
Para, Ombretta
Bacci, Francesca
Nozzoli, Carlo
author_sort Pieralli, Filippo
collection PubMed
description BACKGROUND: Severe sepsis and septic shock are leading causes of morbidity and mortality among critically ill patients, thus the identification of prognostic factors is crucial to determine their outcome. In this study, we explored the value of procalcitonin (PCT) variation in predicting 30-day mortality in patients with sepsis admitted to an intermediate care unit. METHODS: This prospective observational study enrolled 789 consecutive patients with severe sepsis and septic shock admitted to a medical intermediate care unit between November 2012 and February 2014. Kinetics of PCT expressed as percentage were defined by the variation between admission and 72 hours, and 24 and 72 hours; they were defined as Δ-PCT0-72h and Δ-PCT24-72h, respectively. RESULTS: The final study group of 144 patients featured a mean age of 73 ± 14 years, with a high prevalence of comorbidities (Charlson index greater than 6 in 39%). Overall, 30-day mortality was 28.5% (41/144 patients). A receiver-operating-characteristic (ROC) analysis identified a decrease of Δ-PCT0-72h less than 15% (area under the curve: 0.75; 95% confidence interval (CI): 0.67 - 0.82) and a decrease of Δ-PCT24-72h less than 20% (area under the curve: 0.83; 95% CI: 0.74 - 0.92) as the most accurate cut-offs in predicting mortality. Decreases of Δ-PCT0-72h less than 15% (HR: 3.9, 95% CI: 1.6 - 9.5; P < 0.0001) and Δ-PCT24-72h less than 20% (HR: 3.1, 95% CI: 1.2 - 7.9; P < 0.001) were independent predictors of 30-day mortality. CONCLUSIONS: Evaluation of PCT kinetics over the first 72 hours is a useful tool for predicting 30-day mortality in patients with severe sepsis and septic shock admitted to an intermediate care unit.
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spelling pubmed-45229892015-08-06 Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit Pieralli, Filippo Vannucchi, Vieri Mancini, Antonio Antonielli, Elisa Luise, Fabio Sammicheli, Lucia Turchi, Valerio Para, Ombretta Bacci, Francesca Nozzoli, Carlo J Clin Med Res Original Article BACKGROUND: Severe sepsis and septic shock are leading causes of morbidity and mortality among critically ill patients, thus the identification of prognostic factors is crucial to determine their outcome. In this study, we explored the value of procalcitonin (PCT) variation in predicting 30-day mortality in patients with sepsis admitted to an intermediate care unit. METHODS: This prospective observational study enrolled 789 consecutive patients with severe sepsis and septic shock admitted to a medical intermediate care unit between November 2012 and February 2014. Kinetics of PCT expressed as percentage were defined by the variation between admission and 72 hours, and 24 and 72 hours; they were defined as Δ-PCT0-72h and Δ-PCT24-72h, respectively. RESULTS: The final study group of 144 patients featured a mean age of 73 ± 14 years, with a high prevalence of comorbidities (Charlson index greater than 6 in 39%). Overall, 30-day mortality was 28.5% (41/144 patients). A receiver-operating-characteristic (ROC) analysis identified a decrease of Δ-PCT0-72h less than 15% (area under the curve: 0.75; 95% confidence interval (CI): 0.67 - 0.82) and a decrease of Δ-PCT24-72h less than 20% (area under the curve: 0.83; 95% CI: 0.74 - 0.92) as the most accurate cut-offs in predicting mortality. Decreases of Δ-PCT0-72h less than 15% (HR: 3.9, 95% CI: 1.6 - 9.5; P < 0.0001) and Δ-PCT24-72h less than 20% (HR: 3.1, 95% CI: 1.2 - 7.9; P < 0.001) were independent predictors of 30-day mortality. CONCLUSIONS: Evaluation of PCT kinetics over the first 72 hours is a useful tool for predicting 30-day mortality in patients with severe sepsis and septic shock admitted to an intermediate care unit. Elmer Press 2015-09 2015-07-24 /pmc/articles/PMC4522989/ /pubmed/26251686 http://dx.doi.org/10.14740/jocmr2251w Text en Copyright 2015, Pieralli et al. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Pieralli, Filippo
Vannucchi, Vieri
Mancini, Antonio
Antonielli, Elisa
Luise, Fabio
Sammicheli, Lucia
Turchi, Valerio
Para, Ombretta
Bacci, Francesca
Nozzoli, Carlo
Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit
title Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit
title_full Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit
title_fullStr Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit
title_full_unstemmed Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit
title_short Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit
title_sort procalcitonin kinetics in the first 72 hours predicts 30-day mortality in severely ill septic patients admitted to an intermediate care unit
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522989/
https://www.ncbi.nlm.nih.gov/pubmed/26251686
http://dx.doi.org/10.14740/jocmr2251w
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