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Diagnostic Efficacy and Prognostic Value of Serum Procalcitonin Concentration in Patients With Suspected Sepsis

Laboratorio de Analisis Clínicos, Intensivos Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain, mjruizal{at}yahoo.es

S. García-Valdecasas, PhD

Laboratorio de Analisis Clínicos, Intensivos Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain

R. De Pablo, MD, PhD

Unidad de Cuidados, Intensivos Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain

M. Sanchez García, MD, PhD

Unidad de Cuidados Intensivos Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain

C. Coca, MD, PhD

Laboratorio de Analisis Clínicos, Intensivos Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain

T.W. Groeneveld, PhD

Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

A. Roos, PhD

Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

M.R. Daha, PhD

Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

I. Arribas, MD, PhD

Laboratorio de Analisis Clínicos, Intensivos Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain

Background: Procalcitonin is released in response to bacterial infection and it is not released in Inflammatory and viral diseases.

Objective: To show the diagnostic efficacy and prognostic value of procalcitonin for sepsis.

Methods: A consecutive series of 103 patients with suspected sepsis were admitted to the intensive care unit over a 2-year period. During the first 24 hours of the admission procalcitonin, C-reactive protein, and complement proteins were determined. The diagnostic efficacy was tested with predictive values, likelihood ratios, receiver operating characteristic curves, and multiple logistic regression. The association of procalcitonin with mortality was assessed by the Multivariate Cox proportional hazards model.

Results: Procalcitonin had a better positive likelihood ratio than C-reactive protein —2.2 (95% confidence interval: 1.3-3.7) versus 1.1 (95% confidence interval: 0.9-1.2). Sequential Organ Failure Assessment yielded the highest discriminative value, with an area under the curve of 0.82 (95% confidence interval: 0.73-0.92), followed by procalcitonin (0.81; 95% confidence interval: 0.72-0.89). Multivariate regression analysis showed procalcitonin (adjusted odds ratio: 3.8; 95% confidence interval: 1.2-11.8) and Sequential Organ Failure Assessment score (adjusted odds ratio: 5.3; 95% confidence interval: 1.4-19.9) as the only variables independently associated with infection. Multivariate Cox regression analysis revealed that procalcitonin was not independently associated with mortality.

Conclusions: The diagnostic accuracy of procalcitonin was higher than C-reactive protein and complement proteins. Procalcitonin in combination with Sequential Organ Failure Assessment was useful to diagnose infection. C-reactive protein, Sequential Organ Failure Assessment score, age, and gender showed to be helpful to improve the prediction of mortality risk, but not procalcitonin.

Key Words: procalcitonin • C-reactive protein • complement system • diagnosis sepsis • mortality • prognosis

This version was published on January 1, 2009

Journal of Intensive Care Medicine, Vol. 24, No. 1, 63-71 (2009)
DOI: 10.1177/0885066608327095


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