[The predictor value of peripheral blood procalcitonin levels in the evaluation of prognosis of patients with septic shock].

ABSTRACT

OBJECTIVE: To investigate the predictor value of peripheral blood procalcitonin (PCT) levels in the evaluation of prognosis of patients with septic shock. METHODS: A prospective study was conducted. Eighty-four patients with septic shock in intensive care unit (ICU) of Beijing Shijitan Hospital Affiliated to Capital Medical University were enrolled from May, 2011 to January, 2012. Serum PCT levels were monitored, and the acute physiology and chronic health evaluation II (APACHEII) score, sequential organ failure assessment (SOFA) score were recorded at the 1st, 3rd, 5th, and 7th day after admission. According to the 28-day outcome after admission to ICU, the patients with septic shock were divided into the survivor group and non-survivor group, dynamic changes in serum PCT levels were compared between two groups and correlation analysis was carried out on serum PCT levels and the APACHEII score, SOFA score. RESULTS: (1) There was no significant difference in serum PCT levels (µg/L) at the 1st and 3rd day between survivor group (n=38) and non-survivor group (n=46), but the serum PCT levels at the 5th and 7th day in non-survivor group were significantly higher than that in survivor group (5 days 8.79±2.38 vs. 2.38±0.88, 7 days 12.57±3.29 vs. 0.71±0.22, both P<0.05), and the drop of PCT concentrations were significant compared with survivor group (1.91±1.21 vs. 10.27±4.49, P<0.05). At the same time, positive statistical correlation was found between serum PCT levels and APACHEII score, SOFA score (5 days R(APACHEII)=0.395, R(SOFA)=0.396; 7 days R(APACHEII)=0.675, R(SOFA)=0.648, all P<0.01). (2) Receiver operator characteristic curve (ROC curve) of serum PCT levels on the 7th day could significantly predict the 28-day mortality, maximal area under the curve (AUC) of PCT was 0.886. When PCT was 0.965 µg/L, the sensitivity and specificity were appropriate. By multivariate factors logistic regression, serum PCT concentrations were not significantly correlated with 28-day mortality. (3) The median survival time (days) of patients with 7-day PCT <1.0 µg/L was far more than that of the patients with PCT>1.0 µg/L (28.0 vs. 14.1, P<0.05). CONCLUSIONS: Dynamic monitoring of serum PCT levels can help to assessment the prognosis of septic shock and also in predicting the severity of the illness, but it may not be a significant independent prognostic marker for 28-day survival in the patients with septic shock.