Prognostic value of inflammatory markers (notably cytokines and procalcitonin), nutritional assessment, and organ function in patients with sepsis.
OBJECTIVE
Procalcitonin is useful for the diagnosis of sepsis, but its prognostic value regarding mortality is unclear. Our objective was to determine the prognostic value of procalcitonin determined at the onset of sepsis, and to compare it with other markers of inflammatory response, malnutrition and organ dysfunction data.


METHODS
We studied 253 hospitalized patients (146 men, 107 women) with a median age of 65 years. Sepsis was defined as infection, and at least two SIRS criteria. We assessed co-morbidities, nutritional status, bacteremia, procalcitonin and other inflammatory markers (PCR, TNF-alpha, IL6, TREM-1, IL-10, IL-1ra, CD14 and LBP), and organ function using the SOFA score. Mortality was assessed at 28 days after onset of sepsis.


RESULTS
At day 28, 49 (19%) patients had died. Inflammatory markers showed only moderate predictive value for mortality, with IL-10 and IL-6 being the best predictors. Mortality was mainly related to organ dysfunction indicators (SOFA and Glasgow scores), serum lactate, ferritin and LDH levels, and to nutritional data such as subjective assessment, handgrip strength and serum transferrin levels. The most frequent location of sepsis was the lung, with 140 cases (55%), which showed more comorbidity, worse nutritional status, less frequent bacteremia and lower inflammatory response. When the analysis was limited to patients with non-pulmonary sepsis, organ dysfunction, nutritional status and inflammatory markers showed the best prognostic value. Of the inflammatory markers, procalcitonin showed only moderate predictive value; however it showed the highest correlation with bacteremia and the ability to discriminate non-complicated sepsis from severe forms.


CONCLUSIONS
Procalcitonin only showed moderate predictive value for sepsis-related mortality, being surpassed by organ dysfunction, nutritional status, IL-10 and IL-6. However, it proved useful to discriminate between non-complicated and severe forms of sepsis.
Biochemistry laboratory, University Hospital of the Canary Islands, Tenerife, Spain.
Marta
M
Suárez-Santamaría
Francisco
F
Santolaria
Alina
A
Pérez-Ramírez
María-Remedios
MR
Alemán-Valls
Antonio
A
Martínez-Riera
Emilio
E
González-Reimers
María-José
MJ
de la Vega
Antonio
A
Milena
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009928:Organ Specificity; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
D015415:Biomarkers; C000606589:CALCA protein, human; D016207:Cytokines; D018836:Inflammation Mediators; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide