title: The clinical value of procalcitonin and neopterin in predicting sepsis and organ failure after major trauma.
abstract: We examined whether procalcitonin (PCT) or neopterin (NT) are useful in predicting sepsis, multiple organ failure (MOF), or death after multiple trauma (MT). In a prospective clinical study, a total of 137 consecutive trauma patients (mean age 39 years, median injury severity score [ISS] 27 points) and 34 healthy volunteers were enrolled. Blood samples were collected on arrival in the emergency room until day 28 after trauma. Plasma NT was detected by enzyme-linked immunoassay and PCT plasma levels were determined using an immunoluminometric assay. The incidence of sepsis was 65%, MOF 48%, and death in hospital within 28 days 11%. After adjustment for age, gender, and ISS, PCT and NT levels during the first 2 days after injury were unable to differentiate between patients who developed sepsis or not. On the contrary, patients who developed MOF had higher PCT plasma levels on day 0 (0.60 vs. 0.15 ng/mL), and on days 1 and 2 combined (1.95 vs. 0.32 ng/mL). This difference remained significant in multivariate logistic regression (P = 0.01) and additional subgroup analyses for early and late MOF (P = 0.048 and 0.002). For NT, smaller differences were observed (4.39 vs. 3.68 nmol/L, and 7.20 vs. 5.79 nmol/L), which lost significance in multivariate analysis. On the basis of PCT, ISS, and age, a MOF prediction rule was developed and had a good predictive power (area under the curve: 0.77; P < 0.001). These findings demonstrate that high plasma concentrations of PCT in the early posttraumatic phase are an independent predictor of MOF but not of sepsis.
authors.affiliation: Biochemical and Experimental Division and dagger Trauma Surgery Division, 2nd Department of Surgery, University of Cologne, Cologne, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Hensler
authors.forename: Stefan
authors.initials: S
authors.lastname: Sauerland
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Manfred
authors.initials: M
authors.lastname: Nagelschmidt
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.forename: Jonas
authors.initials: J
authors.lastname: Andermahr
authors.forename: Edmund A M
authors.initials: EA
authors.lastname: Neugebauer
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D019540:Area Under Curve; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009102:Multiple Organ Failure / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D019798:Neopterin / Q000097:blood; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications*
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D019798:Neopterin; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide