Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study.
Crit Care. 2011 Mar 7;15(2):R88
Authors: Bloos F, Marshall JC, Dellinger RP, Vincent JL, Gutierrez G, Rivers E, Balk RA, Laterre PF, Angus DC, Reinhart K, Brunkhorst FM
ABSTRACT: INTRODUCTION: To determine whether serum procalcitonin (PCT) levels is associated with prognosis, measured as organ dysfunction and 28 day mortality, in patients with severe pneumonia. METHODS: Multicenter, observational study of critically ill adult patients with pneumonia requiring mechanical ventilation conducted in ten academic hospitals in Canada, the United States, and Central Europe. PCT was measured daily for 14 days using an immuno-luminometric assay. RESULTS: We included 175 patients, 57 with community acquired pneumonia (CAP), 61 with ventilator associated pneumonia (VAP) and 57 with hospital acquired pneumonia (HAP). Initial PCT levels were higher in CAP than VAP patients (median [interquartile range]; 2.4 [0.95-15.8] vs. 0.7 [0.3-2.15], ng/ml, P<0.001) but not significantly different to HAP (2.2 [0.4-8.0] ng/ml). 28-day ICU mortality rate for all patients was 18.3% with a median ICU length of stay of 16 days (range 1-142 days). PCT levels were higher in non-survivors than in survivors. Initial and maximum PCT levels correlated with maximum SOFA score r2=0.50 (95% CI: 0.38-0.61) and r2=0.57 ( 0.46-0.66), respectively. Receiver operating curve analysis on discrimination of 28-days mortality showed areas under the curve of 0.74, 0.70, and 0.69 for maximum PCT, initial PCT, and APACHE II score, respectively. The optimal cut-off to predict mortality for initial PCT was 1.1 ng/ml (odds ratio 7.0 [95% CI 2.6-25.2]) and that for maximum PCT was 7.8 ng/ml (odds ratio 5.7 [95% CI 2.5-13.1]). CONCLUSIONS: PCT is associated with the severity of illness in patients with severe pneumonia and appears to be a prognostic marker of morbidity and mortality comparable to the APACHE II score.
PMID: 21385367 [PubMed - as supplied by publisher]