The Prognostic Role of Procalcitonin in Critically Ill Patients Admitted in a Medical Stepdown Unit: A Retrospective Cohort Study.
Aged
Biomarkers
/ metabolism
Critical Illness
/ mortality
Female
Hospital Mortality
/ trends
Hospitalization
/ statistics & numerical data
Humans
Inflammation
/ diagnosis
Intensive Care Units
/ trends
Male
Organ Dysfunction Scores
Procalcitonin
/ analysis
Prognosis
Retrospective Studies
Survival Rate
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
11 03 2020
11 03 2020
Historique:
received:
04
12
2019
accepted:
26
02
2020
entrez:
13
3
2020
pubmed:
13
3
2020
medline:
24
11
2020
Statut:
epublish
Résumé
Procalcitonin (PCT) is a a marker of bacterial infection. Its prognostic role in the critically-ill patient, however, is still object of debate. Aim of this study was to evaluate the capacity of admission PCT (aPCT) in assessing the prognosis of the critically-ill patient regardless the presence of bacterial infection. A single-cohort, single-center retrospective study was performed evaluating critically-ill patients admitted to a stepdown care unit. Age, sex, Simplified Acute Physiology Score II (SAPS-II), shock, troponin-I, aPCT, serum creatinine, cultures and clinical endpoints (in-hospital mortality or Intensive Care Unit (ICU) transfer) were collected. Time free from adverse event (TF-AE) was defined as the time between hospitalization and occurrence of one of the clinical endpoints, and calculated with Kaplan-Meier curves. We engineered a new predictive model (POCS) adopting aPCT, age and shock.We enrolled 1063 subjects: 450 reached the composite outcome of death or ICU transfer. aPCT was significantly higher in this group, where it predicted TF-AE both in septic and non-septic patients. aPCT and POCS showed a good prognostic performance in the whole sample, both in septic and non-septic patients. aPCT showed a good prognostic accuracy, adding informations on the rapidity of clinical deterioration. POCS model reached a performance similar to SAPS-II.
Identifiants
pubmed: 32161314
doi: 10.1038/s41598-020-61457-6
pii: 10.1038/s41598-020-61457-6
pmc: PMC7066188
doi:
Substances chimiques
Biomarkers
0
Procalcitonin
0
Types de publication
Clinical Trial
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
4531Références
Vijayan, A. L. et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J Intensive Care 5, 51, https://doi.org/10.1186/s40560-017-0246-8 (2017).
doi: 10.1186/s40560-017-0246-8
pubmed: 28794881
pmcid: 5543591
Buratti, T. et al. Plasma levels of procalcitonin and interleukin-6 in acute myocardial infarction. Inflammation 25, 97–100 (2001).
doi: 10.1023/A:1007166521791
Meisner, M. et al. Early increase of procalcitonin after cardiovascular surgery in patients with postoperative complications. Intensive Care Med 28, 1094–1102, https://doi.org/10.1007/s00134-002-1392-5 (2002).
doi: 10.1007/s00134-002-1392-5
pubmed: 12185431
Mitsuma, S. F. et al. Promising new assays and technologies for the diagnosis and management of infectious diseases. Clin Infect Dis 56, 996–1002, https://doi.org/10.1093/cid/cis1014 (2013).
doi: 10.1093/cid/cis1014
pubmed: 23223587
Schuetz, P. et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 10, CD007498, https://doi.org/10.1002/14651858.CD007498.pub3 (2017).
doi: 10.1002/14651858.CD007498.pub3
pubmed: 29025194
Liu, D. et al. Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis. PLoS One 10, e0129450, https://doi.org/10.1371/journal.pone.0129450 (2015).
doi: 10.1371/journal.pone.0129450
pubmed: 26076027
pmcid: 4468164
Jensen, J. U. et al. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med 34, 2596–602, https://doi.org/10.1097/01.CCM.0000239116.01855.61 (2006).
doi: 10.1097/01.CCM.0000239116.01855.61
pubmed: 16915118
Docherty, A. B. et al. Early troponin I in critical illness and its association with hospital mortality: a cohort study. Crit Care 21, 216, https://doi.org/10.1186/s13054-017-1800-4 (2017).
doi: 10.1186/s13054-017-1800-4
pubmed: 28814347
pmcid: 5559840
Le Gall, J. R., Lemeshow, S. & Saulnier, F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270, 2957–63 (1993).
Prin, M. & Wunsch, H. The role of stepdown beds in hospital care. Am J Respir Crit Care Med 190, 1210–6, https://doi.org/10.1164/rccm.201406-1117PP (2014).
doi: 10.1164/rccm.201406-1117PP
pubmed: 25163008
pmcid: 4315815
Robertson, L. C. & Al-Haddad, M. Recognizing the critically ill patient. Anaesth Intensive Care Med 14, 11–14, https://doi.org/10.1016/j.mpaic.2012.11.010 (2013).
doi: 10.1016/j.mpaic.2012.11.010
Teasdale, G. et al. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol 13, 844–854, https://doi.org/10.1016/S1474-4422(14)70120-6 (2014).
doi: 10.1016/S1474-4422(14)70120-6
pubmed: 25030516
Revisiting respiratory failure | ACP Hospitalist. https://acphospitalist.org/archives/2013/10/coding.htm . (Accessed 28 Oct 2019).
Singer, M. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315, 801, https://doi.org/10.1001/jama.2016.0287 (2016).
doi: 10.1001/jama.2016.0287
pubmed: 26903338
pmcid: 26903338
Vahdatpour, C., Collins, D. & Goldberg, S. Cardiogenic Shock. J Am Heart Assoc 8, e011991, https://doi.org/10.1161/JAHA.119.011991 (2019).
doi: 10.1161/JAHA.119.011991
pubmed: 30947630
pmcid: 6507212
Vincent, J.-L. & De Backer, D. Circulatory Shock. N Engl J Med 369, 1726–1734, https://doi.org/10.1056/NEJMra1208943 (2013).
doi: 10.1056/NEJMra1208943
pubmed: 24171518
pmcid: 24171518
Burkett, E. et al. Sepsis in the older person: The ravages of time and bacteria. https://doi.org/10.1111/1742-6723.12949 (2018).
doi: 10.1111/1742-6723.12949
Angus, D. C. & van der Poll, T. Severe Sepsis and Septic Shock. N Engl J Med 369, 840–851, https://doi.org/10.1056/NEJMra1208623 (2013).
doi: 10.1056/NEJMra1208623
pubmed: 23984731
Knaus, W. A., Draper, E. A., Wagner, D. P. & Zimmerman, J. E. APACHE II: a severity of disease classification system. Crit Care Med 13, 818–29 (1985).
doi: 10.1097/00003246-198510000-00009
Subbe, C. P., Kruger, M., Rutherford, P. & Gemmel, L. Validation of a modified Early Warning Score in medical admissions. QJM 94, 521–6 (2001).
doi: 10.1093/qjmed/94.10.521
Wacker, C., Prkno, A., Brunkhorst, F. M. & Schlattmann, P. Articles Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. https://doi.org/10.1016/S1473-3099(12)70323-7 (2013).
doi: 10.1016/S1473-3099(12)70323-7