Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock.
OBJECTIVE
To assess whether different diagnostic and prognostic cutoff values of procalcitonin should be considered in surgical and in medical patients with septic shock.


METHODS
Prospective observational study.


METHODS
Intensive care unit of the Avicenne teaching hospital, France.


METHODS
All patients with septic shock or noninfectious systemic inflammatory response syndrome within 48 hrs after admission.


METHODS
None.


RESULTS
Patients were allocated to one of the following groups: group 1 (surgical patients with septic shock), group 2 (surgical patients with noninfectious systemic inflammatory response syndrome), group 3 (medical patients with septic shock), and group 4 (medical patients with noninfectious systemic inflammatory response syndrome). Procalcitonin at study entry was compared between group 1 and group 2 and between group 3 and group 4 to determine the diagnostic cutoff value in surgical and in medical patients, respectively. Procalcitonin was compared between survivors and nonsurvivors from group 1 and group 3 to determine its prognostic cutoff value. One hundred forty-three patients were included: 31 in group 1, 36 in group 2, 36 in group 3, and 40 in group 4. Median procalcitonin levels (ng/mL [interquartile range]) were higher in group 1 than in group 3 (34.00 [7.10-76.00] vs. 8.40 [3.63-24.70], p = .01). In surgical patients, the best diagnostic cutoff value was 9.70 ng/mL, with 91.7% sensitivity and 74.2% specificity. In medical patients, the best diagnostic cutoff value was 1.00 ng/mL, with 80% sensitivity and 94% specificity. Procalcitonin was a reliable early prognostic marker in medical but not in surgical patients with septic shock. A cutoff value of 6.00 ng/mL had 76% sensitivity and 72.7% specificity for separating survivors from nonsurvivors.


CONCLUSIONS
The diagnostic cutoff value of procalcitonin was higher in surgical than in medical patients. Early procalcitonin was of prognostic interest in medical patients.
Clec'h
Christophe
C
Medico-Surgical Intensive Care Unit, Avicenne Teaching Hospital, Bobigny, France.
Fosse
Jean-Philippe
JP
Karoubi
Philippe
P
Vincent
Francois
F
Chouahi
Imad
I
Hamza
Lilia
L
Cupa
Michel
M
Cohen
Yves
Y
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide