Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay.
BACKGROUND
Procalcitonin (PCT) has been proposed as a diagnostic and prognostic sepsis marker, but has never been validated in febrile patients with prolonged ICU stay.


METHODS
Patients were included in the study provided they were hospitalised in the ICU for > 10 days, were free of infection and presented a new episode of SIRS, with fever >38 degrees C being obligatory. Fifty patients fulfilled the above criteria. PCT was measured daily during the ICU stay. The primary outcome was proven infection.


RESULTS
Twenty-seven out of 50 patients were diagnosed with infection. Median PCT on the day of fever was 1.18 and 0.17 ng/ml for patients with and without proven infections (p < 0.001). The area under the curve for PCT was 0.85 (95% CI; 0.71-0.93), for CRP 0.65 (0.46-0.78) and for WBC 0.68 (0.49-0.81). A PCT level of 1 ng/mL yielded a negative predictive value of 72% for the presence of infection, while a PCT of 1.16 had a specificity of 100%. A two-fold increase of PCT between fever onset and the previous day was associated with proven infection (p 0.001) (OR = 8.55; 2.4-31.1), whereas a four-fold increase of PCT of any of the 6 preceding days was associated with a positive predictive value exceeding 69.65%. A PCT value less than 0.5 ng/ml on the third day after the advent of fever was associated with favorable survival (p 0.01).


CONCLUSIONS
The reported data support that serial serum PCT may be a valuable diagnostic and prognostic marker in febrile chronic critically ill patients.
Tsangaris
Iraklis
I
The 2nd Critical Care Department, Attikon University General Hospital, Medical School, University of Athens, 1 Rimini Str,, 12462, Athens, Greece. itsagkaris@med.uoa.gr
Plachouras
Diamantis
D
Kavatha
Dimitra
D
Gourgoulis
George Michael
GM
Tsantes
Argirios
A
Kopterides
Petros
P
Tsaknis
George
G
Dimopoulou
Ioanna
I
Orfanos
Stylianos
S
Giamarellos-Bourboulis
Evangelos
E
Giamarellou
Helen
H
Armaganidis
Apostolos
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D005260:Female; D005334:Fever / Q000097:blood*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000175:diagnosis
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide