Prognostic value of PCT in septic emergency patients

BACKGROUND: An accurate assessment of septic patients at risk for poor clinical outcomes is challenging for clinicians in the emergency department (ED). OBJECTIVES: We aimed to evaluate the prognostic value of procalcitonin (PCT) in septic patients in the ED for predicting death. RESULTS: In a retrospective study, 188 septic patients (median age 63 [IQR 51–80]) of two French university hospitals were included. Patients who deceased within 30 days (20 %, n = 37) presented higher PCT value at admission (median 34.0 µg/L [5.0–71.9]) in comparison with the survivals (median 6.4 µg/L [4.1–13.1], p = 0.0005). ROC curve analysis indicated a moderate AUC of 0.686 [95 % CI 0.613–0.752] and an optimal PCT threshold value at 32.5 [95 % CI 21.8–43.3] µg/L that was associated with a 51 % [34–67] sensitivity, a 96 % [90–98] specificity, a 73 % [52–88] positive predictive value, and a 89 % [83–93] negative predictive value for death. Only 26 patients (14 %) had PCT values above this threshold (19 in the deceased group vs 7 in survival group, p < 0.0001). By multivariate analysis, only three variables remained significantly predictive of the death: personal history of cardiovascular disease (OR 3.1 [1.0–9.4], p = 0.046), the presence of severe sepsis/septic shock in the ER (OR 4.4 [1.3–12.3], p = 0.013), and a PCT level >32.5 µg/L (OR 36.0 [10.0–128.4], p < 0.0001). Similar results were obtained when considering the combined outcome death and/or admission in ICU. CONCLUSION: Elevated value of PCT at admission has moderate accuracy to identify poor outcome in ED septic patients in daily practice.