Mortality higher in severe sepsis patients whose procalcitonin doesn't go down

The study evaluated the relationship between 28-day mortality and a procalcitonin decrease of more than 80% between baseline and hospital day 4 in ICU patients with severe sepsis or septic shock.

Change in procalcitonin levels can predict mortality among patients with severe sepsis or septic shock, according to a recent study.

The prospective observational study included consecutive patients with severe sepsis or septic shock admitted to the ICU at 13 U.S. hospitals. Of 858 enrolled patients, 646 were alive and in the hospital on day 4. Their procalcitonin levels were measured daily over the first five days of hospitalization. The primary outcome of the study was 28-day mortality, and researchers looked for a relationship between this outcome and a procalcitonin decrease of more than 80% between baseline and hospital day 4.

Patients who did not experience such a decrease had double the risk of death at 28 days (20% vs. 10%; P=0.001), the study found. The inability to decrease procalcitonin by more than 80% was confirmed as an independent predictor of mortality in a Cox regression analysis, which adjusted for demographics, Acute Physiology and Chronic Health Evaluation II score, ICU residence on day 4, sepsis syndrome severity, antibiotic administration time, and other confounders (hazard ratio, 1.97; 95% CI, 1.18 to 3.30; P<0.009).

The findings are in line with other research finding prognostic utility to serial procalcitonin measurement, the study authors said. They noted that determining sepsis prognosis is difficult with currently available tools, and biomarkers have been seen as a promising solution. This study supports the approach of monitoring procalcitonin levels over time, the authors said, noting that their secondary analysis showed that a procalcitonin increase even from baseline to day 1 could predict mortality, as patients with an increase had a threefold higher risk. “This simple finding could prove particularly useful during early critical care management,” they wrote.

The authors cautioned that procalcitonin change is not such a precise measurement that it should be used in decisions to withdraw care from patients unlikely to survive. They called for an interventional study to determine whether serial monitoring of procalcitonin can improve clinical decisions and outcomes for sepsis patients. The study was published online by Critical Care Medicine on March 2.